重症肌无力患者外周血AIRE、Tfh细胞和Tfr细胞与病情严重性相关分析

目的探讨自身免疫性调节因子(AIRE)、滤泡辅助性T(Tfh)细胞和滤泡调节性T(Tfr)细胞与重症肌无力(MG)患者病情严重程度的相关性。方法收集2015-12—2016-4第四军医大学唐都医院收治的MG患者22例,根据临床表现分为全身型MG(GMG)和眼肌型MG(OMG);同期选取健康体检中心查体者10名作为健康对照。收集MG患者详细临床资料,包括美国MG协会(MGFA)分型及定量MG(QMG)评分。通过流式细胞术分析AIRE阳性细胞比例及Tfh/Tfr比值。结果 (1)AIRE表达在各组间比较差异具有统计学意义(P0.01)。GMG组和OMG组AIRE表达均较对照组降低(P0.01,P0.05),而GMG组与OMG组间比较差异无统计学意义(P0.05)。(2)Tfh/Tfr比值在各组间比较差异具有统计学意义(P0.01)。GMG组和OMG组Tfh/Tfr比值均高于对照组(P0.01,P0.05),且GMG组高于OMG组(P0.05)。(3)MG患者AIRE表达与MGFA分型及QMG评分呈负相关(r=-0.517,P0.05;r=-0.616,P0.01),Tfh/Tfr比值与MGFA分型和QMG评分呈正相关(r=0.761,r=0.581,均P0.01)。结论 AIRE、Tfh/Tfr比值与MG的病情严重程度有一定的相关性,并可能参与了MG的发病。

The correlation between the expression of AIRE,Tfh and Tfr cells and clinical severity in myasthenia gravis patients

Objective To explore the correlation between the expression of autoimmune regulator (AIRE),T follicular helper (Tfh),T follicular regulatory (Tfr) cells and clinical severity in myasthenia gravis (MG) patients.Methods Clinical data of 22 MG patients were collected at the Department of Neurology,Tangdu Hospital of Fourth Military Medical University from December 2015 to April 2016.The patients were divided into a generalised MG (GMG) group and an ocular MG (OMG) group;at the same time 10 volunteers were chosen as healthy controls from physical examination center.Detailed clinical information of MG patients was collected by questionnaires,including Myasthenia Gravis Foundation of America (MGFA) clinical classification and quantitative Myasthenia Gravis (QMG) score.The ratios of AIRE,Tfh and Tfr cells were measured by flow cytometry.Results (1) The difference of AIRE expression among all the three groups was significant (P＜0.01).The expression of AIRE was lower in the GMG group and the OMG group,compared with the control group (P＜0.01,P＜0.05);but between the GMG group and the OMG group,there was no significant difference (P ＞ 0.05).(2) The difference among all the three groups in ratios of Tfh/Tfr was significant (P＜0.01).The ratios of Tfh/Tfr were higher in the GMG group and the OMG groups than the control group (P＜0.01,P＜0.05),and higher in the GMG group than the OMG group (P＜0.05).(3) The expression of AIRE showed a significantly negative correlation with MGFA classification and QMG score in all the 22 MG patients (P＜0.05,P＜0.01).Meanwhile,the ratio of Tfh/Tfr had a positive correlation with MGFA classification and QMG score in all the MG patients (both P＜0.01).Conclusions AIRE and Tfh/Tfr might have a relationship with the severity of MG and might participate in the pathogenesis of MG.