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。     

重症肌无力患者CD40配体表达的信号传导途径初步探讨

目的研究重症肌无力(MG)患者CD40配体(CD40L)的表达,探讨MG患者CD40L表达的信号传导途径.方法研究对象为急性期MG患者13例.分离血中单个核细胞,分组用刺激剂刺激进行单个核细胞培养(1)纯培养组不加任何刺激剂进行细胞培养;(2)PMA组用PMA和A23187刺激;(3)PHA组用PHA刺激;(4)BLM组加PKC抑制剂BLM后再加PHA刺激培养.培养后用流式细胞仪检测CD40L阳性细胞率及RT-PCR法检测单个核细胞CD40L mRNA表达.结果MG急性期BLM组CD40L阳性细胞率和CD40L mRNA与纯培养组差异无显著性(P＞0.05),而显著低于PMA组和PHA组(P＜0.01).结论在MG中,CD40L的表达可能依赖于PKC活性介导的T细胞活化途径.     

重症肌无力血清中碳酸酐酶Ⅲ其抗体的检测

目的：检测重症肌无力（MG）患者血清中碳酸酐酶Ⅲ（CAⅢ）及其抗体水平，探讨MG骨骼肌减少的CAⅢ是否参与MG的免疫发病。方法：用Western blot检测18例MG患者、16例其他神经肌肉疾病（ONMD）患者和15名健康人血清中CAⅢ水平；用Western blot与酶联免疫吸附测定（ELISA）检测上述血清中抗CAⅢ的抗体水平。结果：Western blot显示，正常人、MG和ONMD患者血清中都存在CAⅢ，但该蛋白的谱带密度在3组人的血清中差异无统计学意义（P〉0．05）；Western blot与ELISA表明，上述血清中不存在抗CAⅢ的抗体。结论：正常人、MG和ONMD患者血清中均存在CAⅢ蛋白，但不存在抗该蛋白的抗体，说明MG骨骼肌减少的CAⅢ蛋白可能没有直接参与MG的免疫发病。     

精神分裂症患者血清c-fos诱导因子和血清蛋白分析

目的　探索精神分裂症患者血清中的病理活性因子。方法　将精神分裂症患者 (10例 )血清与健康人淋巴细胞混合培养 ,观察淋巴细胞c fos基因蛋白的表达情况 ,用自动琼脂糖电泳分析仪检测血清蛋白 ;同时设立内科疾病组 (10例 )及健康人组 (2 4名 )对照做上述试验。结果　在 7 10的精神分裂症患者血清中检出c fos基因蛋白表达诱导因子 ,在内科疾病人组及健康人组中则未检出该因子。精神分裂症组与上述两个对照组之间差异均有非常显著性 (P <0 0 1)。血清蛋白电泳结果表明 :精神分裂症组血清蛋白具有明显的特征性改变 ,与对照组比较差异有非常显著性 (P <0 0 1)。结论　精神分裂症患者血清中有一种促c fos基因蛋白表达的因子 ,其生物活性可能与精神分裂症的病理机制密切相关。     

重症肌无力病人血清非免疫球蛋白成分中的14KD蛋白

在21例抗体阳性、20例抗体阴性重症肌无力(MG),18例其他神经科疾病(OND)患者和19例正常对照血清中制备非免疫球蛋白(Ig)成分。并予以聚丙烯酰胺凝胶电泳(SDS-PAGE)和等电聚焦(IEF)电泳分析。结果显示,大多数MG病人的非Ig成分电泳图谱中有一分子量为14KD的特异蛋白区带,其出现频度以抗体阴性MG(85％)最高,与抗体阳性MG(52.38％)比较差异有显著性(P<0.05)。14KD蛋白可能参与了MG的发病,尤其在抗体阴性MG中的作用可能更为重要。     

重症肌无力患者骨骼肌中碳酸酐酶Ⅲ蛋白减少的原因

目的 分析重症肌无力患者(MG)骨骼肌中碳酸酐酶Ⅲ(CAⅢ)蛋白和CAⅢ mRNA的表达,并与健康对照组进行比较,探讨MG骨骼肌CAⅢ蛋白缺乏的原因.方法 用Western blot分析17例MG患者与19名健康人骨骼肌CAⅢ蛋白的水平,逆转录-聚合酶链反应(RT-PCR)技术分析CAⅢ mRNA的表达.结果 Western blot显示,MG患者骨骼肌CAⅢ蛋白谱带密度低于健康人骨骼肌;经半定量分析,健康人骨骼肌CAⅢ蛋白水平的相对值为1.70±0.29,MG骨骼肌为0.76±0.08,两者差异有统计学意义(P=0.006).RT-PCR半定量结果为:健康人骨骼肌CAⅢ mRNA表达的相对值为0.29±0.04,MG骨骼肌为0.15±0.02,两组间差异亦有统计学意义(P=0.005).分析同一标本CAⅢ蛋白与CAⅢ mRNA表达,约77%的MG患者骨骼肌中两者呈一致性减少.结论 MG骨骼肌CAⅢ蛋白降低的主要原因是其本身CAⅢ mRNA的表达降低所致,骨骼肌CAⅢ mRNA的表达降低与MG发病的关系还需进一步阐明.     

重症肌无力患者血清中抗心磷脂抗体测定的意义

目的 观察IgG-ACA与重症肌无力患者的关系。方法 应用酶联免疫吸附法,测定了94例重症肌无力(MG)患者和40例健康对照者血清中抗心磷脂抗体水平,(IgM-ACA和IgG-ACA)。结果 94例MG患者及40例健康对照者血清中IgM-ACA均为阴性;94例MG患者中30例IgG-ACA阳性(30/94,31.9％),40例健康对照者中仅2例阳性(2/40,5％),二者差异有非常显著性(P<0.01)。血清IgG-ACA水平与患者的年龄、性别、病型均无关(P>0.05),而与胸腺病理密切相关(P<0.01)。30例胸腺瘤患者中,14例阳性(14/30,46.7％),64例不伴胸腺瘤的MG患者中,16例阳性(16/64,25％),二者相比,差异有非常显著性(P<0.01)。IgG-ACA阳性患者中,1/3滴度较高(至少为正常值的2倍)。结论 通过对IgG—ACA的测定,不仅对MG是否合并胸腺瘤起初步筛选作用,而且是MG患者并发凝血机制方面异常的一个警惕性标志。     

重症肌无力患者骨骼肌中减少的25000蛋白即为碳酸酐酶Ⅲ的论证

目的论证重症肌无力(MG)患者骨骼肌中特异性减少的25000蛋白为碳酸酐酶Ⅲ(CAⅢ)分子。方法用双向电泳结合免疫Western blot分析25000蛋白抗体和CAⅢ抗体有免疫反应的蛋白质分子的物化特征,分别用免疫Dot blot与免疫Western blot观察两种抗体对纯化的25000蛋白及骨骼肌蛋白匀浆的竞争结合,用免疫Western blot分析健康人与MG患者骨骼肌CAⅢ的蛋白表达。结果双向电泳结合免疫Western blot显示,25000蛋白抗体和CAⅢ抗体识别的蛋白质具有相同的相对分子质量和等电点;免疫Dot blot与免疫Western blot的竞争结合证实25000蛋白与CAⅢ为同一物质;免疫Western blot表明,用25000蛋白抗体与CAⅢ抗体检测健康人与MG患者骨骼肌25000蛋白表达的结果亦几乎是相同的。结论MG患者骨骼肌特异减少的25000蛋白分子就是CAⅢ,这为进一步深入研究CAⅢ与MG的发病奠定了基础。     

老年重症肌无力的临床特点(123例临床分析)

目的 研究老年重症肌无力(MG)的临床特点。方法 回顾性分析1990-01—2002-05北京医院123例老年MG住院患者的临床特点，并与507例青壮年MG患者进行对比。结果 老年MG患者占同期MG患者的18．14％，男性患者较多(占68．29％)，眼肌首发症状多见(占80．49％)，分型以I型和Ia型多见(占56．10％)，胸腺异常主要为胸腺瘤(占老年MG患者手术病理证实伴发胸腺异常的100％)，低频重复电刺激(RNS)阳性率为74.19％，老年MG危象发生率较低(为2．44％)。结论 老年MG患者具有男性、眼肌首发症状、I型与IA型多见，以及胸腺异常主要为胸腺瘤，而RNS阳性率与MG危象发生率低等临床特点。     

肌肉特异性酪氨酸激酶在重症肌无力中的作用(综述)

约有20％重症肌无力(MG)患者血清中检测不到乙酰胆碱受体抗体(AChRAb)，称之为“血清反应阴性MG”(seronegative MG，SNMG)。有报道71％的SNMG患者血清中存在肌肉特异性酪氨酸激酶(MUSK)抗体(MuSKAb)，MuSKAb阳性SNMG患者的流行病学特征、If缶床特点和治疗效果与由AChRAb介导的MG(seropositive MG，SPMG)有所不同，存在较大争议。     

Myasthenia gravis patients with a thymoma have antibodies against a high molecular weight protein in sarcoplasmic reticulum.

Our purpose was to investigate whether components of the sarcoplasmic reticulum (SR) are relevant antigens in myasthenia gravis (MG). Using enzyme-linked immunosorbent assay (ELISA), 75 MG sera and 120 control sera were examined for IgG antibodies against SR prepared from rabbit skeletal muscle. 16/30 thymoma MG patients had IgG antibodies that reacted with SR. 1/30 MG patients with thymic hyperplasia and 3/15 MG patients with thymic atrophy had SR antibodies in low concentrations. Control sera were negative. Using immunoblot, SR antibodies were detected in the thymoma group only. 14/30 sera from thymoma patients reacted with a protein of 320 kDa relative molecular weight. The only reported SR protein with similar electrophoretic mobility is the subunit of the spanning protein which links junctional SR to sarcolemma and functions as a calcium-release channel.     

Detection of antibodies to citric acid extract of skeletal muscle (CAE-ab) in the sera of patients with myasthenia gravis using indirect hemagglutination

In this paper are described the method and results for the demonstration of the antibodies to citric acid extract of skeletal muscle (CAE-ab) in the sera from myasthenia gravis (MG) patients with or without thymoma, in patients with other diseases and in healthy controls by an indirect hemagglutination assay (IHA), were described. The CAE-ab titers were positive in 15 (71.43%) of the 21 MG patients with thymoma, the antibody titers ranging from 1:16 to 1:512. In the 35 MG patients without thymoma, as well as in the 32 healthy controls and 22 patients with other diseases, the antibody titers were all negative A statistically significant difference was found between the CAE-ab titers in the group of MG patients with thymoma and those in the other three groups. It was considered that IHA for the purpose of demonstrating CAE-ab could serve as a supplementary diagnostic method for early detection of thymoma in MG patients at an early stage.     

重症肌无力患者IL-1活性变化的研究

本文对42例重症肌无力（MG）患者及40例正常对照外周血单个核细胞分必IL-1活性进行了检测，并对14例MG患者在应用糖皮质激素（GC），一月后IL-1活性变化进行了观察。结果：MG患者IL活性明显高于正常对照，MG患者IL-1活性变化与AchRab产生密切相关，与MG临床类型、病情、愈后密切相关，GC治疗后IL-1活性明显降低，结果提示IL-1参与了MG的发生、发展，检测IL-1活性对指导MG临床有重要的参考价值。GC可能通过抑制IL-1参与了MG的发生、发展，检测IL-1活性对指导MG临床有重要的参考价值，GC可能通过抑制IL-1活性而发挥其免疫治疗作用。     

Glucocorticoid receptors of mononuclear leukocytes from myasthenia gravis patients

The present study was performed to analyse glucocorticoid receptor (GR) binding in peripheral blood mononuclear leukocytes (MNL) from 39 myasthenia gravis (MG) patients (unoperated patients (n = 13), thymectomized patients (n = 14) and patients receiving glucocorticoids: thymectomized (n = 11) and unoperated (n = 6]. A whole cell binding assay with 3(H) dexamethasone was used. GR mean values were significantly higher in the MNL of MG patients (thymectomized or not) not receiving glucocorticoid than in the MNL of healthy donors. Affinity was within the normal range. Sex, age or clinical forms of illness did not influence the results. In patients receiving prednisone (Pd) the GR values were significantly lower than in MG patients without Pd therapy, independent of Pd dose or time of administration. No differences in receptor binding between normal subjects and MG patients receiving Pd have been found.     

负性协同刺激分子PD-1在重症肌无力患者外周血中的表达

目的 观察重症肌无力(MG)患者外周血中负性协同刺激分子programmed death-1( PD-1)的表达情况，并探讨其与MG发病的关系。方法 采用免疫荧光标记、流式细胞仪检测45例MG患者和33名健康对照者外周血单个核细胞中PD-1及其配体PD-L1的表达，用ELISA法检测各组血浆中可溶性PD-1的水平。结果 (1)MG患者表达PD-1的CD4+T淋巴细胞比例增加，CD14+PD-L1+的单核细胞比例增加，但在不同性别及眼肌型与全身型间差异无统计学意义；在胸腺异常MG患者中CD4+PD-1+T细胞增加，CD14+ PD-L1+的单核细胞比例减少；早发型MG患者（年龄＜40岁）CD4+PD-1+T淋巴细胞比例明显低于晚发型（年龄≥40岁）。(2)MG患者血浆中sPD-1浓度为(6.92 +0.72) ng/ml，明显高于健康对照组的(3.28±0.42) ng/ml，但在性别、MG眼肌型与全身型不同类型间和有无胸腺异常各组间差异无统计学意义，且sPD-1与发病年龄呈负相关(r=-0.526，P=0.000)。结论 PD-1及PD-L1途径参与了MG的发病，异常升高的sPD-1可能干扰了正常的细胞膜上PD-1与PD-L1的结合，从而促使疾病进展。     

重症肌无力患者血清Th1/Th2/Th17细胞因子的变化及意义

目的：分析重症肌无力（MG）患者血清CD4^＋ T细胞主要细胞因子的水平,探讨不同亚型CD4^＋ T细胞分泌的细胞因子在MG发病机制中的作用。方法：用ELISA测定93例MG患者和34名健康对照者血清中各项细胞因子（IL-2、IL-12、IFN-γ、TNF-α、IL-4、IL-10、IL-13和IL-17）的水平,分组行统计学分析。结果：与健康对照组相比,MG患者Th1细胞相关各细胞因子（IL-2、IL-12、IFN-γ及TNF-α）均明显升高,差异有统计学意义（P〈0.05）;Th2细胞相关的细胞因子IL-4、IL-10差异无统计学意义（P〉0.05）,仅IL-13水平升高;Th17细胞的细胞因子IL-17水平差异无统计学意义（P〉0.05）。MG眼肌型与全身型患者血清中各细胞因子水平的差异无统计学意义（P〉0.05）,在不同病程的MG患者中差异也无统计学意义（P〉0.05）。结论：Th1细胞因子在MG发病机制中发挥重要作用,而Th2细胞及其细胞因子在MG机制中的角色各异。     

The role of complement in myasthenia gravis: serological evidence of complement consumption in vivo

BACKGROUND: Antibodies to the acetylcholine receptor (AChR) titin and the ryanodine receptor (RyR) occur in myasthenia gravis (MG). These antibodies are capable of complement activation in vitro. The involvement of the complement system should cause consumption of complement components such as C3 and C4 in vivo. MATERIALS AND METHODS: Complement components C3 and C4 were assayed in sera from 78 AChR antibody-positive MG patients and 52 healthy controls. Forty-eight of the patient sera contained titin antibodies as well, and 20 were also RyR antibody-positive. RESULTS: MG patients with AChR antibody concentrations above the median (11.2 nmol/l) had significantly lower mean C3 and C4 concentrations in serum compared to those with AChR antibody concentrations below the median. Titin antibody-positive MG patients, titin antibody-negative early-onset MG patients, titin antibody-negative late-onset MG patients, and controls had similar C3 and C4 concentrations. Nor did mean C3 and C4 concentrations differ in MG patients with RyR antibodies. Patients with severe MG (grades 4 and 5) had similar C3 and similar C4 levels compared to those with mild MG (grades 1 and 2). CONCLUSION: An increased in vivo complement consumption was detected in MG patients with high AChR antibody concentrations, unrelated to MG severity and non-AChR muscle antibodies.     

High anti-EBNA-1 IgG levels are associated with early-onset myasthenia gravis

Background: Myasthenia gravis (MG) is an autoimmune disorder mediated by antibodies against the acethylcholine receptor (AchR) of the neuromuscular junction in the majority of patients. Methods: Here, we examined IgG antibodies against the type 1 nuclear antigen of Epstein‐Barr virus (EBNA‐1) in the sera of 158 patients with MG compared to 184 healthy controls. Results: Although serum concentration in the sera was not different, high anti‐EBNA‐1 IgG titers (above 90th percentile of the normal values) were more common in the patients (26.6 vs. 16.3%, P = 0.024). In addition, high EBNA‐1 IgG levels occurred more frequently amongst the 94 patients with early‐onset myasthenia gravis (EOMG, 30.8%) as compared to the 64 patients with late‐onset disease (LOMG, 14.1%) (P = 0.021). Using multiple logistic regression, high serum concentration of the anti‐EBNA‐1 IgG antibodies was significantly associated with EOMG (OR: 3.17, P = 0.027), even after adjustment for sex, presence/absence of anti‐AchR antibodies and presence/absence of anti‐Titin antibodies. Out of 39 patients with EOMG, who underwent thymectomy, 18 patients (46%) had thymoma, 6 had thymic hyperplasia (15%), and 15 patients had thymic atrophy (39%); there was no difference comparing EBNA‐1 antibody titers in the sera. As no correlation was found between the titers of anti‐AchR, anti‐Titin, and EBNA‐1 antibodies, a dysregulated heterogeneous B‐cell response was unlikely to be responsible for the elevated levels of EBV‐associated antibody in patients. Conclusions: In summary, our data suggest that high levels of EBNA‐1 antibodies are more common in MG compared to healthy controls and are especially associated with EOMG.