重症肌无力患者细胞和体液免疫指标变化及糖皮质激素治疗的效果

Changes of Cellular and Humoral Immune Indices in Patients with Myasthenia Gravis and the Effect of Glucocorticoid Therapy

目的研究重症肌无力(myastheniagravis,MG)患者细胞和体液免疫指标变化情况及糖皮质激素的治疗效果。方法选取石家庄市第一医院2017年3月—2018年10月收治的MG患者78例作为MG组,另选取同期来我院体检中心行健康体检的身体健康者51例作为对照组。MG组给予糖皮质激素中等剂量冲击并小剂量维持治疗6个月,比较MG组治疗前和对照组细胞免疫指标[外周血CD4^+、CD8^+、CD4^+/CD8^+及干扰素γ(INF-γ)、转化生长因子β1(TGF-β1)、白细胞介素6(IL-6)、白细胞介素18(IL-18)]、体液免疫指标(IgG、IgA、IgM及补体C3、C4)水平;比较MG组治疗前后上述细胞免疫、体液免疫指标水平;观察MG组治疗结果及安全性。结果MG组治疗前CD4^+、CD4^+/、CD8^+、IL-6、IL-18、INF-γ水平较对照组明显升高,、CD8^+、TGF-β1水平较对照组明显降低(P<0.05或P<0.01)。与对照组相比,MG组治疗前IgG水平升高,IgA、C3、C4水平降低(P<0.05)。治疗后,MG组CD4^+、CD4^+/、CD8^+、IL-6、IL-18、INF-γ水平较治疗前明显降低,、CD8^+、TGF-β1水平较治疗前明显升高(P<0.05或P<0.01);治疗后,MG组IgG水平较治疗前降低,IgA、C3、C4水平较治疗前升高(P<0.05)。MG组治疗后完全缓解62例,好转16例;且治疗期间未发现明显不良反应。结论MG患者体内存在细胞免疫及体液免疫的双重免疫紊乱状态;MC患者予糖皮质激素中等剂量冲击并小剂量维持治疗,有利于改善症状、恢复体内免疫紊乱状态,且安全性良好。

Objective To study the changes of cellular and humoral immune indexes in patients with myasthenia gravis (MG) and the effect of glucocorticoid on the treatment of this disease. Methods Seventy-eight MG patients admitted to Shijiazhuang First Hospital from March 2017 to October 2018 were selected as MG group, and 51 healthy persons who underwent physical examination in the physical examination center of our hospital during the same period were selected as control group. MG group was given medium dose of glucocorticoid and low dose maintenance therapy. After 6 months of treatment, the cellular immune indexes (CD 4 ^+, CD 8 ^+, CD 4 ^+/CD 8 ^+ and interferon-γ,TGF-β1, interleukin-6 (IL-6), interleukin-18 (IL-18), humoral immune indexes (IgG, IL-18) of MG group and control group were compared before and after treatment. The levels of IgA, IgM and complement C3 and C4 were compared before and after treatment in MG group, and the therapeutic results and safety of MG group were observed. Results Before treatment, the levels of CD 4 ^+, CD 4 ^+/CD 8 ^+, IL-6, IL-18 and INF-γ in MG group were significantly higher than those in control group, while the levels of CD 8 ^+, TGF-β1 were significantly lower than those in control group ( P <0.05 or P <0.01). Compared with the control group, the levels of IgG increased and IgA, C3 and C4 decreased in MG group before treatment, with statistical significance ( P <0.05). After treatment, the levels of CD 4 ^+, CD 4 ^+/CD 8 ^+, IL-6, IL-18 and INF-γ in MG group were significantly lower than those before treatment, and the levels of CD 8 ^+, TGF-β1 were significantly higher than those before treatment ( P <0.05 or P <0.01);after treatment, the levels of IgG in MG group were lower than those before treatment, and the levels of IgA, C3 and C4 were higher than those before treatment ( P <0.05). In MG group, 62 cases recovered after 3 months of treatment, 16 cases improved, and no invalid cases were found, and no obvious adverse reactions were found during treatment. Conclusion There are two immune disorders in MG patients: cellular immunity and humoral immunity. MC patients treated with medium dose of glucocorticoid and low dose maintenance therapy are helpful to restore the immune disorder in vivo, and the safety is good.