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重症肌无力中的肌肉自身抗体:超越诊断?

Muscle autoantibodies in myasthenia gravis: beyond diagnosis?

机构信息

Department of Neurology and Rehabilitation, College of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA.

出版信息

Expert Rev Clin Immunol. 2012 Jul;8(5):427-38. doi: 10.1586/eci.12.34.

Abstract

Myasthenia gravis is an autoimmune disorder of the neuromuscular junction. A number of molecules, including ion channels and other proteins at the neuromuscular junction, may be targeted by autoantibodies leading to abnormal neuromuscular transmission. In approximately 85% of patients, autoantibodies, directed against the postsynaptic nicotinic acetylcholine receptor can be detected in the serum and confirm the diagnosis, but in general, do not precisely predict the degree of weakness or response to therapy. Antibodies to the muscle-specific tyrosine kinase are detected in approximately 50% of generalized myasthenia gravis patients who are seronegative for anti-acetylcholine receptor antibodies, and levels of anti-muscle-specific tyrosine kinase antibodies do appear to correlate with disease severity and treatment response. Antibodies to other muscle antigens may be found in the subsets of myasthenia gravis patients, potentially providing clinically useful diagnostic information, but their utility as relevant biomarkers (measures of disease state or response to treatment) is currently unclear.

摘要

重症肌无力是一种神经肌肉接头的自身免疫性疾病。许多分子,包括神经肌肉接头处的离子通道和其他蛋白质,可能成为自身抗体的靶标,导致异常的神经肌肉传递。在大约 85%的患者中,可在血清中检测到针对突触后烟碱型乙酰胆碱受体的自身抗体,从而确诊,但通常并不能准确预测肌无力的程度或对治疗的反应。在大约 50%的全身性重症肌无力患者中,抗肌肉特异性酪氨酸激酶抗体呈阳性,而这些患者对乙酰胆碱受体抗体呈阴性,并且抗肌肉特异性酪氨酸激酶抗体的水平似乎与疾病的严重程度和治疗反应相关。在重症肌无力患者的亚群中可能会发现针对其他肌肉抗原的抗体,这些抗体可能提供有临床价值的诊断信息,但它们作为相关生物标志物(疾病状态或治疗反应的衡量指标)的效用目前尚不清楚。

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