乙酰胆碱受体和横纹肌抗体能否预测重症肌无力患者是否存在胸腺瘤？
Do acetylcholine receptor and striated muscle antibodies predict the presence of thymoma in patients with myasthenia gravis?
机构信息
Neuromuscular Section, Division of Neurology, Department of Medicine, Duke University Medical Center, DUMC 3403, Durham, North Carolina, 27710, USA.
出版信息
Muscle Nerve. 2014 Jan;49(1):30-4. doi: 10.1002/mus.23882. Epub 2013 Jul 17.
INTRODUCTION
Acetylcholine receptor (AChR) and striated muscle antibodies (StrAbs) are found frequently in myasthenia gravis (MG) patients with thymoma. In this study we aimed to determine the positive predictive value (PPV) and negative predictive value (NPV) of these antibodies for thymoma in patients with MG.
METHODS
Antibody findings, thymic histology, and onset age were reviewed for 1141 patients with MG. PPV and NPV of these antibodies for thymoma were determined.
RESULTS
The PPV of AChR binding antibodies plus StrAbs was highest (50.0%) with onset before the age of 40 years. The PPV of all antibodies was low (<9%) after age 40. Higher StrAb levels did not increase the PPV. The NPV of AChR binding antibodies was high (99.7%) for all ages.
CONCLUSIONS
Patients without AChR binding antibody are not likely to have a thymoma. StrAbs and AChR binding antibodies are not diagnostic for thymoma, but in early-onset MG their presence should raise the clinical suspicion for thymoma.
简介
乙酰胆碱受体（AChR）和横纹肌抗体（StrAbs）在胸腺瘤合并重症肌无力（MG）患者中经常发现。在这项研究中，我们旨在确定这些抗体对 MG 患者胸腺瘤的阳性预测值（PPV）和阴性预测值（NPV）。
方法
对 1141 例 MG 患者的抗体检测结果、胸腺组织学和发病年龄进行了回顾性分析。确定了这些抗体对胸腺瘤的 PPV 和 NPV。
结果
AChR 结合抗体加 StrAbs 的 PPV 最高（50.0%），发病年龄在 40 岁以前。40 岁以后，所有抗体的 PPV 均较低（<9%）。StrAb 水平升高并不能增加 PPV。AChR 结合抗体的 NPV 在所有年龄段均较高（99.7%）。
结论
无 AChR 结合抗体的患者不太可能患有胸腺瘤。StrAbs 和 AChR 结合抗体对胸腺瘤无诊断价值，但在早发性 MG 中，其存在应提高对胸腺瘤的临床怀疑。
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