重症肌无力伴发甲状腺异常的临床分析

目的 分析重症肌无力(MG)合并甲状腺异常患者的临床特点.方法 回顾性分析2008年7月-2009年9月同期住院的300例MG患者临床资料,比较260例甲状腺正常及40例伴甲状腺异常的MG患者临床特点,血清甲状腺抗体与乙酰胆碱受体抗体水平的相关性及外周血T淋巴细胞亚群百分比情况.结果 (1)合并甲状腺异常的MG占13.3%,MG伴甲状腺异常以出现甲状腺抗体阳性为多见(30例,占10.0%);(2)甲状腺正常与异常的MG患者在发病性别构成、年龄分布、病程、临床分型及胸腺病理上差异均无统计学意义;(3)伴有甲状腺抗体阳性MG患者血突触后膜乙酰胆碱受体水平(1.15±0.11)显著高于甲状腺抗体阴性者(1.01±0.11);(4)甲状腺异常组CD8+T淋巴细胞百分比(21.63±5.17)%明显低于甲状腺正常组(24.28±5.79)%,P＜0.05,CD4+/CD8+比值甲状腺异常组明显高于正常组(2.10±0.67比1.81±0.61,P＜0.05).结论 MG合并甲状腺异常以甲状腺抗体阳性多见,伴有甲状腺抗体阳性MG患者血突触后膜乙酰胆碱受体水平显著升高;MG合并甲状腺异常者其外周血T淋巴细胞亚群紊乱更为明显.

The clinical features of myasthenia gravis associated with thyroid abnormalities

Objective To analyze the clinical characteristics of myasthenia gravis(MG) associated with thyroid abnormalities.Methods A total of 300 MG patients admitted to the department of neurology from July 2008 to September 2009 were reviewed retrospectively.Based on the thyroid function and abnormality of thyroid related antibodies (thyroglobulin antibody and peroxidase antibody), the patients with MG were divided into two groups (260 cases without thyroid disease and 40 cases with thyroid abnormalities).The different clinical features, the relationship between the antithyroid antibodies and antiacetylcholine receptor antibody (AChRAb) and the distribution of T cell subsets between the two groups were compared.Results ( 1 ) Among the 300 MG patients, 13.3% of them was accompanied with thyroid disease and the most common abnormality was positive thyroid antibody.(2) Between the groups of MG with and without thyroid abnormalities, no significant differences on the sex percentage, age of onset, duration of disease, clinical classification and thymic abnormalities were found ( P ＞ 0.05 ).( 3 ) The blood levels of AChRAb in postsynaptic membrane in the thyroid antibody-positive patients were 1.15 ± 0.11, being much higher than those in the antibody-negative patients ( 1.01 ±0.11 ).(4) The percentage of CD8+ T cells was significantly decreased (21.63 ±5.17)% vs (24.28 ±5.79)%] and the ratio of CD4+/CD8+ T cells was increased (2.10 ± 0.67 vs 1.81 ± 0.61, P ＜ 0.05 ) in the group of MG with thyroid abnormality as compared with the group of MG with normal thyroid.Conclusion In MG patients the incidence positive thyroid related antibodies was much higher than that of other thyroid abnormalities.It is suggested that there are higher levels of AChRAb in MG coexisting with positive thyroid antibodies and more abnormalities of T lymphocyte subset distribution in MG patients with thyroid disease.