重症肌无力不同抗体类型的免疫学特征

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Abstract Objective To explore the clinical characteristics of different antibody types and the relationship with other immune factors in myasthenia gravis.Methods A total of 155 patients with myasthenia gravis （MG） who were admitted to Shenzhen People′s Hospital and Shenzhen Longhua District Central Hospital from January 2017 to December 2018 were enrolled in the study.The anti-acetylcholine receptor antibody (AChR Ab) and antibody to muscle-specific kinase(MuSK Ab) in serum were determined by enzyme-linked immunosorbent assay.Patients were divided into AChR Ab positive (+) MG group,MuSK Ab positive (+) MG group and double seronegative (DSN) MG group according to the expression of AChR Ab antibody and MuSK Ab.The clinical manifestations,laboratory tests,thymic pathology and treatment programs of the three groups were analyzed.Results Among the 155 MG patients included in this study,the composition ratios of AChR Ab (+)MG,MuSK Ab (+)MG,and DSN MG were 66.4%,8.4%,and 25.2% respectively.After comparison,MuSK Ab (+) MG group was more likely to involve the muscles of the ball than the remaining two groups,the difference was statistically significant (P＜0.05).There was no significant difference in the proportion of myasthenic crisis among the all groups (P＞0.05).The AChR Ab(+)MG group had a higher thyroid abnormality rate and autoantibody positive rate than the remaining two groups,and the difference was statistically significant (P＜0.05).The incidence of thymoma among the AChR Ab(+)MG group,MuSK Ab(+)MG group,and DSN MG group was 55.3%,23.1%,and 25.6%,respectively.Comparing each subgroup,the AChR Ab(+)MG group had a higher the incidence of thymoma than the remaining two groups,the difference was statistically significant (P＜0.05).Conclusion With the different expressions of AChR Ab and MuSK Ab,MuSK Ab(+)MG was more likely to present bulbar muscles or extraocular muscles and the muscles are more limited.AChR Ab (+)MG is prone to abnormal thyroid function and has a higer autoantibody positive rate.AChR Ab(+)MG are prone to be associated with thymoma.

Key words： Myasthenia gravis Anti-acetylcholine receptor antibody Antibody to muscle-specific kinase Thyroid dysfunction Autoantibody

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