病程及补体水平对眼肌型重症肌无力患儿疗效的影响研究

目的 探讨补体水平随病程的改变情况及其对眼肌型重症肌无力（OMG）患儿疗效的影响。 方法 选取2007年1月—2013年10月在湖南省儿童医院神经科门诊或住院治疗的OMG患儿134例。根据发病时间分为A（＜30 d，n=48）、B（30 d～，n=44）、C（3～6个月，n=42）3组。3组患儿均采用同一治疗方案(即嗅吡斯的明加激素治疗)，采用免疫比浊法检测体液免疫IgG、IgA、IgM、IgE及补体3（C3）、补体4（C4）水平，采用定量重症肌无力评分(QMG)评价OMG疗效。 结果 3组IgG、IgA、IgM、IgE、C4水平间差异无统计学意义（P＞0.05）；而C3水平间差异有统计学意义（P＜0.05），其中B、C组均低于A组，差异有统计学意义（P＜0.05）。3组临床疗效间差异无统计学意义（P＞0.05）。3组治疗前后QMG间差异均无统计学意义（P＞0.05）；3组治疗后QMG均低于治疗前，差异有统计学意义（P＜0.05）。C3与病程呈负相关（rs=-0.235，P＜0.05）；C4与病程无相关性（rs=-0.140，P＞0.05）。将3组数据合并后对治疗前后QMG的影响因素分别进行多元线性回归分析，结果均未得到回归方程。3组数据合并后对C3的影响因素进行多元线性回归分析，结果得到回归方程：C3=1.064-0.001×病程。 结论 病程对C3有一定影响，而对C4无明显影响；C3、C4水平短期内对OMG患儿疗效的影响不大。

Influence of Course of Disease and Complement Levels on the Curative Effects of Children with Ocular Myasthenia Gravis

Objective To investigate the changes of complement levels within the course of disease and its influence on the curative effects of children with ocular myasthenia gravis (OMG).Methods 134 children with OMG,who had been in the Neurological Clinic of Hunan Children′s Hospital or received treatment in this hospital from January 2007 to October 2013,were selected in the study.According to their onset time,patients were divided into A group (＜30 d,n=48）,B group (30 d～,n=44） and C group (3～6 m,n=42).The three groups were treated with the same treatment plan (that was pyridostigmine bromide with prednisone).Immunoturbidimetry was used to detect humoral immunity as IgG,IgA,IgM,IgE and complement 3(C3) and complement 4 (C4) levels,and quantitive MG score (QMG) was applied to evaluate the effects of OMG.Results There were no significant difference in IgG,IgA,IgM,IgE and C4 levels among the three groups (P＞0.05);while there was significant difference in the C3 levels among the three groups (P＜0.05),the C3 levels of B and C group were significantly lower than those of A group(P＜0.05).There was no significant difference in clinical effect among the three groups（P＞0.05）.There was no significant difference in QMG of the three groups before and after treatment (P＞0.05);QMG of the three groups after treatment was significantly lower than that of the three groups before treatment (P＜0.05).C3 was negatively correlated with the course of the disease(rs=-0.235,P＜0.05);C4 was not correlated with the course of the disease (rs=-0.140,P＞0.05).Multiple linear regression analysis was applied to study the influencing factors of QMG before and after treatment after merging the data of the three groups,and no regression equation was got from the results.The regression equation-C3=1.064-0.001×course was got through the multiple linear regression analysis of the influence factors of the C3 groups after merging the data of the three groups.Conclusion There is certain influence of course of disease on C3,but no influence are found in C4.C3 and C4 levels have little impact on the therapeutic efficacy in short term.