重症肌无力患者血清Titin抗体和RyR抗体的临床研究

摘要

Objective To investigate serum Titin antibody and Ryanodine receptor (RyR) antibody levels in patients with myasthenia gravis (MG) and their clinical significance. Methods Serum Titin antibody and RyR antibody were detected with enzyme- linked immunosorbent assay (ELISA) in 61 MG patients (MG group) and 35 healthy subjects (control group). Results The positive rates of Titin antibody and RyR antibody were 62.3% and 49.2% in MG group, those in control group were 11.4% and 8.6%(both P<0.001). The positive rates of Titin antibody in MG patients with thymoma (MGT)was significantly higher than that in those without thymoma(NTMG)(P <0.01). There was no significant difference in RyR antibody positive rate between MGT group and NTMG group (P>0.05). The positive rates of Titin antibody(80.0%) and RyR antibody (63.3%) were higher in late- onset MG patients than those in early- onset MG patients (both P <0.05). The positive rate of serum Titin antibody in generalized or severe MG patients (ⅡA, ⅡB, Ⅲ, Ⅳ type) was significantly higher than that in ocular MG ( I type ) patients ( P <0.01) , while no significant difference was observed in positive rate of RyR antibody ( P >0.05). In MG patients, the level of Titin antibody and RyR antibody was positively correlated with the severity of muscle weakness (r = 0.520 and 0.487, both P<0.001). Conclusion Serum Titin antibody and/or RyR antibody levels may be of value in diagnosis of MG and the severity of the disease. In addition, Titin antibody may distinguish MGT from NTMG and Osserman calssification.%目的：探讨重症肌无力（MG）患者血清Titin抗体和Ryanodine受体（RyR）抗体的临床意义。方法采用ELISA法检测61例MG患者和35例健康体验者（正常对照组）的血清Titin抗体、RyR抗体、AChR抗体。结果 MG组Titin抗体和RyR抗体阳性率均显著高于对照组（均P＜0.001）；合并胸腺瘤MG（MGT）组患者Titin抗体阳性率明显高于未合并胸腺瘤MG（NTMG）组（P＜0.01）；MGT组和NTMG组患者RyR抗体阳性率差异无统计学意义（P＞0.05）；晚发型MG患者中Titin抗体和RyR抗体阳性率均明显高于早发型MG患者（均P＜0.05）；全身型或重症型（ⅡA、ⅡB、Ⅲ、Ⅳ型）Titin抗体阳性率显著高于眼肌型（Ⅰ型）（P＜0.01），而两组间RyR抗体阳性率未见统计学差异（P＞0.05）；MG患者Titin抗体和RyR抗体水平与肌无力严重程度相关分析呈正相关（r=0.520、0.487，均P＜0.01）。结论 Titin抗体和RyR抗体检测有助于MG的诊断，且Titin抗体有助于鉴别MG患者是否伴随胸腺瘤及进行Osserman分型。Titin抗体与RyR抗体水平还与MG患者病情的严重程度相关，可应用于评估MG患者的病情与预后。