重症肌无力患者血清中Ryanodine受体抗体对其症状学的评估作用

背景临床工作中对伴胸腺瘤重症肌无力患者仍存在漏诊,从而贻误治疗.目的探讨Ryanodine受体(ryanodinereceptor,RyR)抗体在重症肌无力(myasthenia gravis,MG)评估中的意义.设计病例分析.单位一所大学医院的神经病学研究所.对象实验于1999-06/2002-03在复旦大学神经病学研究所实验室完成.66例伴胸腺瘤MG(MGT组)、98例非胸腺瘤MG(NTMG组)和50例非重症肌无力(NMG组)及123例正常人(NC组)为研究对象.方法以差速离心方法提取富含RyR的肌质网提取物(SR),建立ELISA-RyR抗体检测系统.主要观察指标研究对象血清中RyR抗体水平.结果MGT组RyR抗体阳性检出率显著性高于NTMG组,NMG组(P＜0.01),敏感性和特异性分别达81.8%,94.5%.不同胸腺组织学类型MGT之间RyR抗体阳性检出率差异无显著性意义(P＞0.05).RyR抗体呈阳性MG组的年龄、临床评分和AchR-ab水平均显著高于RyR抗体呈阴性MG组(P＜0.01).RyR抗体水平同MG患者临床症状的严重程度呈正相关,尤其是MGT组(r=0.626,P＜0.01).不同胸腺组织学类型MGT中尤以上皮细胞型相关性最高(r=0.592,P＜0.01).结论RyR抗体检测对诊断MGT具有较高的敏感性和特异性,并且与MG患者临床症状的严重程度呈正相关.

Serum ryanodine receptor antibody on the assessment of clinical symptoms in patients with myasthenia gravis

BACKGROUND: Myasthenia gravis (MG) patients with thymoma were often neglected in clinical work and delayed the therapy.OBJECTIVE: To investigate the significance of the Ryanodine receptor (RyR) antibody on the assessment of MG.DESIGN: A case analysis.SETTING: Institute of neurology in a hospital of a university.PARTICIPANTS: This experiment was carried out in the Institute of Neurology, Fudan University from June 1999 to March 2002. There were 66 MG patients with thymoma(MGT group), 98 MG patients with non-thymoma (NTMG group), 50 patients with non-myasthenia gravis(NMG) and 123 normal persons (NC group).METHODS: Sarcoplasmic reticulum(SR) abounded in RyR was extracted with differential centrifugation, in order to establish a detecting system of ELISA-RyR-RyR antibody (RyR-ab).MAIN OUTCOME MEASURES: The levels of RyR-ab in serum of researched subjects.RESULTS: Positive rate of RyR-ab in MGT group was higher than that in NTMG and NMG groups(P ＜ 0.01), moreover, the sensitivity and the specificity were 81.8% and 94.5% respectively. The positive rates of MGT groups with different thymus histology were no significant difference(P＞ 0.05). Ages, clinical scores and levels of acetylcholine receptor antibody (AchR-ab) in patients with positive RyR-ab were higher than those in patients with negative RyR-ab( P ＜ 0.01 ) in MG group. The levels of RyR-ab was positive correlated with the severities of clinical symptoms in MG patients, especially the patients in MGT group( r = 0. 626, P ＜ 0.01) . And among the different histological types of MGT, thymoma of epithelioid cells has the highest correlation coefficient ( r = 0. 592, P ＜ 0. 01).CONCLUSION: The detection of RyR-ab has better sensitivity and specificity for the diagnosis of MGT and the levels of RyR-ab is positive correlatied with the severities of MG patients.