Dau P C, Lindstrom J M, Cassel C K, Denys E H, Shev E E, Spitler L E
N Engl J Med. 1977 Nov 24;297(21):1134-40. doi: 10.1056/NEJM197711242972102.
Plasmapheresis combined with prednisone and azathioprine therapy produced striking clinical improvement in five patients with myasthenia gravis who still had moderate to severe disability despite thymectomy, high-dose prednisone therapy and optimal doses of cholinesterase inhibitors. Serial determinations of titers of serum antibody toward the acetylcholine receptor demonstrated a fall to 21 +/- 5 per cent (mean +/- S.D.) of the original levels concurrently with the patients' increasing strength. Clinically improved patients maintained lowered titers, whereas clinical relapses were associated with a rebound in titer. Our results suggest that plasmapheresis will find a place in the management of patients with myasthenia gravis, and they implicate antibodies to acetylcholine receptor as a pathogenic factor in this disease.
对于五名重症肌无力患者，尽管接受了胸腺切除术、大剂量泼尼松治疗以及最佳剂量的胆碱酯酶抑制剂治疗，但仍有中度至重度残疾，而血浆置换联合泼尼松和硫唑嘌呤治疗使他们的临床症状得到了显著改善。对乙酰胆碱受体血清抗体滴度的系列测定表明，随着患者肌力增强，抗体滴度降至原来水平的21±5%（平均值±标准差）。临床症状改善的患者抗体滴度维持在较低水平，而临床复发则与滴度反弹有关。我们的结果表明，血浆置换在重症肌无力患者的治疗中将占有一席之地，并且提示乙酰胆碱受体抗体是该疾病的致病因素。
