重症肌无力患者对糖皮质激素的敏感性与糖皮质激素受体的关系

目的　了解重症肌无力(MG)患者对糖皮质激素(GC)敏感性与糖皮质激素受体(GR)的关系。 方法　观察10例MG患者及10名健康对照。采用 3　H-地塞米松( 3　H-DEX)放射配体法测定外周血单个核细胞(PBMC)GR。分别用植物血凝素(PHA)、髓鞘碱性蛋白(MBP)、乙酰胆碱受体(AChR)刺激PBMC， 3　H-TdR掺入法检测体外淋巴细胞增殖反应，地塞米松(DEX)抑制淋巴细胞增殖反应。 结果　正常对照及MG患者PBMC对PHA及MBP刺激的增殖反应差别不显著(P>,0 .05)。而MG患者PBMC对AChR的反应明显高于正常对照者(P<,0 .01)。DEX对MG患者PBMC特异性增殖反应的抑制率为42 .14%, 而对正常对照PBMC的增殖反应的抑制率为21 .62％，两组间有很显著区别(P<,0 .01)。GR数与DEX抑制率间有很良好的相关关系(r=0 .943, P<,0 .01)。 结论　MG PBMC GR数与体外DEX对PBMC 特异性增殖反应的抑制效应有良好的一致性。DEX对抗原特异性淋巴细胞增殖反应的抑制性可作为了解MG患者对GC敏感性的一项指标。

The Relation Between the Sensitivity of Patients with MyastheniaGravis to Glucocorticoids and Glucocorticoid Receptors

Objective　To explore the relation between the sensitivity of patients with myasthenia gravis to glucocorticoids and glucocorticoid receptors . Methods　Ten patients with MG and 10 healthy controls were studied for glucocorticoid receptors in peripheral blood mononuclear cells by 3H-dexamethansone binding assay and for lymphocyte proliferation by 3H-TdR incorporation assay . Lymphocyte proliferation was induced by PHA, MBP, or AChR, respectively, and was inhibited by dexamethansone . Results　PBMC proliferation stimulated by PHA or MBP was not significantly different between MG patients and healthy subjects(P>,0 .05) . But PBMC proliferation stimulated by AChR in MG patients was much higher than that in healthy individuals (P<,0 .01) . Inhibition rate of specific PBMC proliferation by DEX was 42 .14% in MG patients and 21 .62％ in healthy subjects(P<,0 .01) . GR numbers were well correlated with inhibition rate of PBMC specific proliferation by DEX(r=0 .943, P<,0 .01) . Conclusion　GR numbers of PBMC in MG patients are coincidentally with the inhibiting effects of dexamethansone to specific PBMC proliferation . The inhibition rate of specific PBMC proliferation by DEX could be used as a parameter for judging the sensitivity of MG patients to GC .