四种抗体阳性重症肌无力合并类风湿性关节炎的病例特征分析

Analysis of case characteristics of four kinds of antibody-positive patient with myasthenia gravis complicated with rheumatoid arthritis

目的探讨4种抗体阳性重症肌无力(MG)合并类风湿性关节炎(RA)的诊断学特征。方法回顾性分析2020年6月14日河北省沧州中西医结合医院风湿免疫科收治的1例4种抗体阳性的MG合并RA患者的临床资料,并复习相关文献。结果患者4年6个月前出现眼睑下垂伴周身乏力,吞咽困难,对称性多关节肿痛,先后诊断为MG、RA,给予溴吡斯的明片、醋酸泼尼松片、甲氨蝶呤片、来氟米特片、硫酸羟氯喹片治疗,上述症状好转,因停用溴吡斯的明片且醋酸泼尼松片减量后,病情复发。完善MG相关抗体检查后发现,乙酰胆碱受体(AChR)抗体、肌肉特异性酪氨酸激酶(MuSK)抗体、兰尼碱受体(RyR)抗体、乙酰胆碱酯酶(AChE)抗体同时阳性,调整治疗方案为醋酸泼尼松片、环孢素软胶囊、溴吡斯的明片后,病情逐渐缓解。结论MG合并RA患者中可检测到4种抗体阳性,提示自身免疫重叠中,可同时存在不同抗体介导的致病机制。

Objective To explore the diagnostic features of four antibody-positive patient with myasthenia gravis(MG)combined with rheumatoid arthritis(RA).Methods The clinical data of a MG patient with four antibody-positive combined with RA in the Rheumatology Department of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively analyzed,and related literatures were reviewed.Results The patient was diagnosed with MG and RA with ptosis,fatigue,dysphagia,symmetrical polyarticular swelling and pain four years and six months ago.He was given pyridostigmine bromide,prednisone acetate,methotrexate,leflunomide and hydroxychloroquine,and the above symptoms improved.Due to the discontinuation of pyridostigmine bromide and prednisone acetate reduction,the disease recurred.After perfecting the MG-related antibodies examinations,it was found that the acetylcholine receptor(AChR)antibody,the muscle-specific tyrosine kinase(MuSK)antibody,the ryanodine receptor(RyR)antibody,and the acetylcholinesterase(AChE)antibody were positive at the same time.Adjusting the treatment plans to prednisone acetate,cyclosporine and pyridostigmine bromide,the condition was gradually eased.Conclusion Four kinds of antibodies can be detected in patients with MG and RA,suggesting that different antibody-mediated pathogenic mechanisms may exist in autoimmune overlap.