蛋白A免疫吸附治疗重症肌无力的临床观察

目的探讨蛋白A免疫吸附治疗重症肌无力（MG）的临床疗效。方法采用病例对照方法,将24例MG患者非随机分为2组。治疗组12例,对照组12例,治疗组在传统治疗方法的基础上,给予蛋白A免疫吸附治疗,每周3次,共4周。对照组不进行蛋白A吸附治疗。治疗前和治疗后抽取清晨空腹血,测IgG、IgA、IgM、补体C3、C4和采用酶联免疫吸附法测乙酰胆碱受体抗剂（AChR-Ab）,并根据疗效标准临床相对评分法进行评分。结果治疗组总有效率为91.67%（11/12）,对照组总有效率为75%（9/12）,差异有统计学意义（P〈0.05）。治疗组免疫球蛋白IgG、IgA、IgM和AchR-Ab下降程度较对照组明显降低（P〈0.01）。结论蛋白A免疫吸附能有效降低MG血液中AchR-Ab和免疫球蛋白水平,比单纯药物治疗疗效好,是治疗MG的有效方法。

Clinical observation of protein A immunoadsorption in treatment of myasthenia gravis

Objective To evaluate the efficacy of protein A immunoadsorption on myasthenia gravis. Methods A total of 24 myasthenia gravis cases were divided into two groups： The treatment group （n=12） and the control group （n=12）. Patients in both groups were treated with the traditional therapy, but those in the treatment group received protein A immunoadsoption 3 times per week for 4 weeks. Serum immunoglobulins of IgG, IgA and IgM, complements of C3 and C4, and antibodies against nicotinic acetylcholine receptor were determined before and after the treatment. The efficacy of protein A immunoadsorption on myasthenia gravis patients was evaluated by a scoring system based on physical examinations. Results The overall rate of effectiveness was 91.67% in the treatment group and 75% in the control group （P〈0.05）. The numbers of patients showing complete recovery, significant recovery, improvement, response and no response were 5, 2, 3, 1 and 1, respectively, in the treatment group, and were 2, 2, 2, 3 and 3, respectively, in the control group. Serum IgG, IgA and IgM and antibodies against the nicotinic acetylcholine receptor decreased more remarkably in the treatment group than in the control group （P 〈 0.01）. Conclusions Protein A immunoadsorption significantly lowered serum IgG, IgA, IgM and antibodies against the nicotinic acetylcholine receptor, and shortened the disease course in myasthenia gravis patients. Therefore, it is an effective method and can be used in association with the traditional therapy for myasthenia gravis patients.