Zhou Xia, Sun Zhong-wu
Department of Neurology, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China.
Zhonghua Yi Xue Za Zhi. 2013 May 7;93(17):1287-91.
To explore the correlations of serum total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL) and uric acid (UA) with myasthenia gravis (MG).
A total of 131 MG patients were selected as MG group and 176 healthy cases as control group. They were enrolled from the Department of Neurology, First Affiliated Hospital, Anhui Medical University between January 2010 and December 2012. And the controls were recruited from a health check-up center. The total serum BIL and UA concentrations were measured by an enzymatic method. All MG patients underwent thymus computed tomography (CT) scanning.
The serum levels of TBIL, IBIL and UA in patients with MG ((11.0 ± 0.4, 7.4 ± 0.3, 270 ± 70) µmol/L) were significantly lower than those in healthy control group ((13.0 ± 0.4, 9.6 ± 0.3, 301 ± 60) µmol/L) (P < 0.01). Moreover, these results were consistent when the male and female cohorts were investigated separately. In MG group, females had significantly lower serum TBIL, IBIL and UA levels ( (10.1 ± 3.7, 6.7 ± 2.7, 242 ± 68) µmol/L) than males ((12.2 ± 5.5, 8.4 ± 4.2, 288 ± 73) µmol/L) (P < 0.05-0.01). However, no difference existed when comparing different grades of MG patients according to the modified Osserman classification. Also no significant difference existed between MG patients with thymic abnormalities and those without. In comparison with the subjects in the reference group (total bilirubin ≥ 11.4 µmol/L, UA ≥ 279 µmol/L), the odds ratio (95% CI) for MG patients in the lower tertile (total bilirubin < 11.4 µmol/L, UA < 279 µmol/L) were 1.98 (1.20-3.29) and 2.22 (1.29-3.82) respectively after multivariable adjustment. Serum level of TBIL and UA had positive correlations with creatinine as indicated by Pearson correlation analysis (r = 0.151, P = 0.008; r = 0.301, P = 0.000). Meanwhile, serum level of UA had a negative correlation with high density lipoprotein-cholesterol (r = -0.347, P = 0.000) .
Decreased serum levels of BIL and UA are closely correlated with MG. As a replacement therapy, administration of BIL and UA or theirs precursors may offer benefits to the MG patients.
探讨血清总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）及尿酸（UA）与重症肌无力（MG）的相关性。
选取131例MG患者作为MG组，176例健康者作为对照组。研究对象于2010年1月至2012年12月来自安徽医科大学第一附属医院神经内科，对照组来自健康体检中心。采用酶法测定血清总胆红素和尿酸浓度。所有MG患者均接受胸腺计算机断层扫描（CT）。
MG患者血清TBIL、IBIL和UA水平（(11.0±0.4, 7.4±0.3, 270±70)μmol/L）显著低于健康对照组（(13.0±0.4, 9.6±0.3, 301±60)μmol/L）（P<0.01）。此外，男女队列分别研究时结果一致。MG组中，女性血清TBIL、IBIL和UA水平（(10.1±3.7, 6.7±2.7, 242±68)μmol/L）显著低于男性（(12.2±5.5, 8.4±4.2, 288±73)μmol/L）（P<0.05-0.01）。然而，根据改良Osserman分类比较不同等级MG患者时无差异。胸腺异常的MG患者与无胸腺异常的患者之间也无显著差异。与参照组（总胆红素≥11.4μmol/L，UA≥279μmol/L）受试者相比，三分位数较低组（总胆红素<11.4μmol/L，UA<279μmol/L）的MG患者经多变量调整后的优势比（95%CI）分别为1.98（1.20-3.29）和2.22（1.29-3.82）。Pearson相关分析表明，血清TBIL和UA水平与肌酐呈正相关（r=0.151，P=0.008；r=0.301，P=0.000）。同时，血清UA水平与高密度脂蛋白胆固醇呈负相关（r=-0.347，P=0.000）。
血清BIL和UA水平降低与MG密切相关。作为替代疗法，给予BIL和UA或其前体可能对MG患者有益。
