重症肌无力患者对糖皮质激素的敏感性与糖皮质激素受体的关系

摘要

Objective　To explore the relation between the sensitivity of patients with myasthenia gravis to glucocorticoids and glucocorticoid receptors . Methods　Ten patients with MG and 10 healthy controls were studied for glucocorticoid receptors in peripheral blood mononuclear cells by 3H-dexamethansone binding assay and for lymphocyte proliferation by 3H-TdR incorporation assay . Lymphocyte proliferation was induced by PHA, MBP, or AChR, respectively, and was inhibited by dexamethansone . Results　PBMC proliferation stimulated by PHA or MBP was not significantly different between MG patients and healthy subjects(P,0 .05) . But PBMC proliferation stimulated by AChR in MG patients was much higher than that in healthy individuals (P,0 .01) . Inhibition rate of specific PBMC proliferation by DEX was 42 .14% in MG patients and 21 .62％ in healthy subjects(P,0 .01) . GR numbers were well correlated with inhibition rate of PBMC specific proliferation by DEX(r=0 .943, P,0 .01) . Conclusion　GR numbers of PBMC in MG patients are coincidentally with the inhibiting effects of dexamethansone to specific PBMC proliferation . The inhibition rate of specific PBMC proliferation by DEX could be used as a parameter for judging the sensitivity of MG patients to GC .%目的　了解重症肌无力(MG)患者对糖皮质激素(GC)敏感性与糖皮质激素受体(GR)的关系。 方法　观察10例MG患者及10名健康对照。采用 3　H-地塞米松( 3　H-DEX)放射配体法测定外周血单个核细胞(PBMC)GR。分别用植物血凝素(PHA)、髓鞘碱性蛋白(MBP)、乙酰胆碱受体(AChR)刺激PBMC， 3　H-TdR掺入法检测体外淋巴细胞增殖反应，地塞米松(DEX)抑制淋巴细胞增殖反应。 结果　正常对照及MG患者PBMC对PHA及MBP刺激的增殖反应差别不显著(P,0 .05)。而MG患者PBMC对AChR的反应明显高于正常对照者(P,0 .01)。DEX对MG患者PBMC特异性增殖反应的抑制率为42 .14%, 而对正常对照PBMC的增殖反应的抑制率为21 .62％，两组间有很显著区别(P,0 .01)。GR数与DEX抑制率间有很良好的相关关系(r=0 .943, P,0 .01)。 结论　MG PBMC GR数与体外DEX对PBMC 特异性增殖反应的抑制效应有良好的一致性。DEX对抗原特异性淋巴细胞增殖反应的抑制性可作为了解MG患者对GC敏感性的一项指标。