乙酰胆碱受体抗体浓度与重症肌无力个体临床症状之间无相关性：一项涉及 67 例患者的系统回顾性研究。
No correlation between acetylcholine receptor antibody concentration and individual clinical symptoms of myasthenia gravis: A systematic retrospective study involving 67 patients.
机构信息
Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China.
出版信息
Brain Behav. 2021 Jul;11(7):e02203. doi: 10.1002/brb3.2203. Epub 2021 Jun 2.
OBJECTIVE
To investigate the correlation between acetylcholine receptor antibodies (AChR-Ab) concentration levels and individualized clinical symptoms in patients with AChR myasthenia gravis (AChR-MG) in China.
METHODS
ELISA was used to determine the concentration of AChR-Ab in patients with MG. The Myasthenia Gravis Foundation of America (MGFA) Clinical Classification, Quantitative Myasthenia Gravis (QMG) score, and MG-specific activities of daily living (MG-ADL) scoring systems were used to evaluate the clinical status of patients. Spearman correlation analysis was used to determine the correlation between the AChR-Ab concentration and clinical score. The changes in the antibody concentration and clinical score are shown in MGFA-antibody concentration-treatment plots.
RESULTS
Autoantibody detection tests were performed in 67 patients, and their clinical scores were recorded. Forty-nine patients received immunosuppressive therapy, 17 patients received pyridostigmine only, and 1 patient under thymectomy without any medication. The AChR-Ab concentration correlated with the MGFA Classification in 5 (29.4%) patients in the pyridostigmine-only group and 15 (30.6%) patients in the immunosuppressive drug group. The changes in the MGFA Classification preceded the changes in the AChR-Ab concentration in 4 (23.5%) patients treated with pyridostigmine and 10 (20.4%) patients on immunosuppressive drugs. In patients on oral non-steroidal immunosuppressants, the AChR-Ab concentration changed by more than 50%, whereas the MGFA Classification did not increase. The AChR-Ab concentration decreased in 17/32 (53.1%) patients after thymectomy, and then increased, whereas the AChR-Ab concentration increased in 15/32 (46.9%) patients and the MGFA Classification decreased in 27/32 (81.8%) patients after thymectomy. The AChR-Ab concentration presented a slight correlation with the corresponding MGFA, QMG, and MG-ADL in patients with thymoma.
DISCUSSION
In the Chinese AChR-MG population, the Changes in the AChR-Ab concentration in individuals with AChR-MG did not consistently correlate with the severity of clinical symptoms.
目的
探讨中国乙酰胆碱受体抗体（AChR-Ab）阳性重症肌无力（AChR-MG）患者抗体浓度与个体化临床症状的相关性。
方法
采用酶联免疫吸附试验（ELISA）法检测患者的 AChR-Ab 浓度，采用美国重症肌无力基金会（MGFA）临床分型、定量重症肌无力（QMG）评分和重症肌无力日常生活活动（MG-ADL）评分系统评估患者的临床状态，采用 Spearman 相关分析判断 AChR-Ab 浓度与临床评分的相关性，根据 MGFA-抗体浓度-治疗图显示抗体浓度和临床评分的变化。
结果
对 67 例患者进行了自身抗体检测，记录了他们的临床评分。49 例患者接受免疫抑制剂治疗，17 例患者仅接受吡啶斯的明治疗，1 例患者接受胸腺切除术且未服用任何药物。在仅接受吡啶斯的明治疗的 5 例（29.4%）和接受免疫抑制剂治疗的 15 例（30.6%）患者中，AChR-Ab 浓度与 MGFA 分型相关。在接受吡啶斯的明治疗的 4 例（23.5%）和接受免疫抑制剂治疗的 10 例（20.4%）患者中，AChR-Ab 浓度的变化先于 MGFA 分类的变化。口服非甾体类免疫抑制剂的患者 AChR-Ab 浓度变化超过 50%，但 MGFA 分类没有增加。胸腺切除术后 17/32（53.1%）患者 AChR-Ab 浓度下降，然后升高，而 15/32（46.9%）患者 AChR-Ab 浓度升高，32/32（81.8%）患者 MGFA 分类降低。胸腺瘤患者的 AChR-Ab 浓度与相应的 MGFA、QMG 和 MG-ADL 呈轻度相关。
讨论
在中国的 AChR-MG 人群中，AChR-MG 患者的 AChR-Ab 浓度变化与临床症状的严重程度不一致。
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