联合检测AchR-Ab和抗横纹肌抗体对重症肌无力的诊断价值

Diagnostic value of combined detection of AchR-Ab and anti rhabdomus antibody in myasthenia gravis

目的研究乙酰胆碱受体抗体(AchR-Ab)和抗横纹肌抗体(AsM-Ab)两种血清自身抗体联合检测对重症肌无力(MG)的诊断价值。方法选择从2018年11月至2019年12月在该院初次诊断为MG的患者150例为MG组,选取同期门诊或住院患有除MG之外的其他自身免疫病患者70例为其他自身免疫病(OAD)组,以及同期体检健康者80例作为健康对照组。采用酶联免疫吸附试验(ELISA)、间接荧光免疫法(IFA)分别测定AchR-Ab、AsM-Ab,比较其抗体阳性率并对结果进行分析。结果MG患者AchR-Ab和AsM-Ab的阳性率分别为80.67%、57.33%,均明显高于OAD组和健康对照组,差异有统计学意义(P<0.05);两种自身抗体联合检测,其灵敏度和特异度分别为92.60%和95.00%。不同Osserman分型患者AsM-Ab阳性率比较,差异有统计学意义(P<0.05)。结论AchR-Ab和AsM-Ab是诊断MG的标志性抗体,联合检测提高了MG的诊断效率,可以降低单项检测的误诊和漏诊;此外,AsM-Ab可作为判断MG病情严重程度的指标,有利于临床制订针对性的治疗方案。

Objective To study the diagnostic value of combined detection of acetylcholine receptor antibody(AchR-Ab)and anti striated muscle antibody(AsM-Ab)in patients with myasthenia gravis(MG).Methods From November 2018 to December 2019,150 patients with myasthenia gravis diagnosed for the first time in Affiliated Hospital of Liaoning university of traditional Chinese medicine were selected as MG group,70 patients with other autoimmune diseases except myasthenia gravis in outpatient or inpatient during the same period were selected as OAD group,and 80 patients with physical examination during the same period were selected as control group.Enzyme linked immunosorbent assay(ELISA)was used to detect AchR-Ab and indirect fluorescent immunoassay(IFA)was used to AsM-Ab.The positive rate of antibody was compared and the result was analyzed.Results The positive rates of AchR-Ab and AsM-Ab in MG patients were 80.67%and 57.33%respectively,which were significantly higher than those in the OAD group and the control group,and the differences were statistically significant(P<0.05).The sensitivity and specificity of the two autoantibodies were 92.60%and 95.00%respectively.Patients with modified Osserman has different positive rate of AsM-Ab,and the differences were statistically significant(P<0.05).Conclusion AchR-Ab and AsM-Ab are the markers of MG diagnosis.Combined detection can improve the efficiency of MG diagnosis and reduce the misdiagnosis and missed diagnosis of single detection.In addition,AsM-Ab can be used as an index to judge the severity of MG,which is conducive to the clinical development of targeted treatment programs.