免疫吸附疗法治疗晚发型重症肌无力

目的 观察蛋白A免疫吸附（IA）治疗对晚发型重症肌无力（MG）相关抗体的清除效果及短期临床疗效。 方法 随机选取25例晚发型MG患者，其中10例MG患者接受IA治疗，15例接受丙种球蛋白（0.4 g·kg-1·d-1）冲击治疗5 d。观察两组治疗前后血清中特异性标志物连接素抗体（Titin-ab）、抗乙酰胆碱受体抗体（AchR-ab）、突触前膜抗体（PrsmR-ab）的变化，同时测定治疗前后定量重症肌无力（QMG）评分。比较两组患者治疗有效率、临床症状缓解时间、呼吸机使用人数和平均住院天数的差异，并分析3种抗体水平的下降和QMG评分改善的相关性。 结果 与治疗前比较，治疗后免疫吸附组和丙种球蛋白组的Titin-ab（P/N值）、AchR-ab（P/N值）、PrsmR-ab（P/N值）均显著下降（均P < 0.05）。其中免疫吸附组的Titin-ab下降幅度显著大于丙种球蛋白组（54.7%±3.5%比19.9%±3.1%，P < 0.05）。免疫吸附组的QMG评分下降幅度显著大于丙种球蛋白组（42.4%±4.2%比23.8%±3.7%，P < 0.05）。免疫吸附组的治疗有效率显著高于丙种球蛋白组（70%比40%，P < 0.05）；临床症状开始缓解的时间也明显缩短[（5.38±0.42） d 比 （8.40±1.54） d，P < 0.01]；呼吸机使用人数（1/10 比 6/15，P < 0.05）和平均住院天数[（13.50±0.50） d比(16.00±0.50) d，P < 0.05]均低于丙种球蛋白组。相关分析显示Titin-ab的下降幅度和QMG评分下降呈正相关（r = 0.6315，P < 0.01）。 结论 免疫吸附疗法能快速有效清除晚发型重症肌无力患者体内的致病抗体，短期疗效优于丙种球蛋白。

Immunoadsorption therapy in late-onset myasthenia gravis

Objective To investigate the removal effect of immunoadsorption (IA) on associated antibodies and the efficacy in late-onset myasthenia gravis (MG). Methods A total of 25 late-onset MG patients were randomly selected to enroll in this study. IA therapy was given to 10 patients(IA group), while immunoglobin (0.4 g·kg-1·d-1) was administrated to the other 15 patients for 5 days(Ig group). The titers of Titin antibody (Titin-ab), acetylcholine receptor antibody (AchR-ab) and presynaptic membrane antibody (PrsmR-ab) were detected before and after the treatment. Quantitive MG (QMG) score was assessed before and immediately after the entire course of treatment. The clinical efficacy, the duration of respiratory support and in-hospital were compared between two groups. The correlation between three antibodies and QMG score was also analyzed. Results Compared with that before treatment, the Titin-ab P/N values, the AchR-ab P/N values, and the PrsmR-ab P/N values of IA group were all decreased significantly after treatment(P<0.05, respectively). The P/N value of Titin-ab in IA group was decreased by 54.7%±3.5%, which was significantly higher than that in Ig group(19.9%±3.1%) (P<0.01). QMG score reduced by 42.4%±4.2% and 23.8%±3.7% in IA group and Ig group respectively (P<0.01, respectively). Symptoms were effectively ameliorated by both treatments, but the effective power of IA group was higher than that of Ig group(70% vs 40%, P<0.05). Remission time of IA group was significantly shorter than that of Ig group [(5.38±0.42) d vs (8.4±1.54) d, P=0.008), so was the duration of in-hospital [(13.50±0.50) d vs (16.50±0.50) d, P<0.05). The number of respiratory support in IA group was less than that in Ig group (1/10 vs 6/15, P<0.05). By the Pearson correlation analysis, the decrease of Titin-ab showed a better longitudinal correlation with the decrease of QMG score than the other two antibodies (r=0.6315, P<0.01). Conclusion IA can rapidly and effectively clear the pathogenic antibodies of late-onset MG patients and its short-term clinical efficacy is better than immunoglobin.