CAJ | 학술논문

目的观察蛋白A免疫吸附(IA)治疗对晚发型重症肌无力(MG)相关抗体的清除效果及短期临床疗效.方法随机选取25例晚发型MG患者,其中10例MG患者接受LA治疗,15例接受丙种球蛋白(0.4 g·kg-1·d-1)冲击治疗5 d.观察两组治疗前后血清中特异性标志物连接素抗体(Titin-ab)、抗乙酰胆碱受体抗体(AchR-ab)、突触前膜抗体(PrsmR-ab)的变化,同时测定治疗前后定量重症肌无力(QMG)评分.比较两组患者治疗有效率、临床症状缓解时间、呼吸机使用人数和平均住院天数的差异,并分析3种抗体水平的下降和QMG评分改善的相关件.结果与治疗前比较,治疗后免疫吸附组和丙种球蛋门组的Titin-ab(PIN值)、AchR-ab(P/N值)、PrsmR-ab(P/N值)均显著下降(均P<0.05).其中免疫吸附组的Titin-ab下降幅度显著大于丙种球蛋白组(54.7%±3.5%比19.9%±3.1%,P<0.05).免疫吸附组的QMG评分下降幅度显著大于丙种球蛋白组(42.4%±4.2%比23.8%±3.7%,P<0.05).免疫吸附组的治疗有效率显著高于丙种球蛋白组(70%比40%,P<0.05);临床症状开始缓解的时间也明显缩短[(5.38±0.42)d比(8.40±1.54)d,P<0.01];呼吸机使用人数(1/10比6/15,P<0.05)和平均住院大数[(13.50±0.50)d比(16.00±0.50)d,P<0.05]均低于丙种球蛋门组.相关分析显示Titin-ab的下降幅度和QMG评分下降呈正相关(r=0.6315,P<0.01).结论免疫吸附疗法能快速有效清除晚发型重症肌无力患者体内的致病抗体,短期疗效优于丙种球蛋白.
목적 관찰단백A면역흡부(IA)치료대만발형중증기무력(MG)상관항체적청제효과급단기림상료효.방법 수궤선취25례만발형MG환자,기중10례MG환자접수LA치료,15례접수병충구단백(0.4 g·kg-1·d-1)충격치료5 d.관찰량조치료전후혈청중특이성표지물련접소항체(Titin-ab)、항을선담감수체항체(AchR-ab)、돌촉전막항체(PrsmR-ab)적변화,동시측정치료전후정량중증기무력(QMG)평분.비교량조환자치료유효솔、림상증상완해시간、호흡궤사용인수화평균주원천수적차이,병분석3충항체수평적하강화QMG평분개선적상관건.결과 여치료전비교,치료후면역흡부조화병충구단문조적Titin-ab(PIN치)、AchR-ab(P/N치)、PrsmR-ab(P/N치)균현저하강(균P<0.05).기중면역흡부조적Titin-ab하강폭도현저대우병충구단백조(54.7%±3.5%비19.9%±3.1%,P<0.05).면역흡부조적QMG평분하강폭도현저대우병충구단백조(42.4%±4.2%비23.8%±3.7%,P<0.05).면역흡부조적치료유효솔현저고우병충구단백조(70%비40%,P<0.05);림상증상개시완해적시간야명현축단[(5.38±0.42)d비(8.40±1.54)d,P<0.01];호흡궤사용인수(1/10비6/15,P<0.05)화평균주원대수[(13.50±0.50)d비(16.00±0.50)d,P<0.05]균저우병충구단문조.상관분석현시Titin-ab적하강폭도화QMG평분하강정정상관(r=0.6315,P<0.01).결론 면역흡부요법능쾌속유효청제만발형중증기무력환자체내적치병항체,단기료효우우병충구단백.
Objective To investigate the removal effect of immunoadsorption (IA) on associated antibodies and the efficacy in late-onset myasthenia gravis (MG). Methods A total of 25 late-onset MG patients were randomly selected to enroll in this study. IA therapy was given to 10 patients (IA group), while immunoglobin (0.4 g·kg-1·d-1) was administrated to the other 15 patients for 5 days(Ig group). The titers of Titin antibody (Titin-ab), acetylcholine receptor antibody (AchR-ab) and presynaptic membrane antibody (PrsmR-ab) were detected before and after the treatment. Quantitive MG (QMG) score was assessed before and immediately after the entire course of treatment. The clinical efficacy, the duration of respiratory support and in-hospital were compared between two groups. The correlation between three antibodies and QMG score was also analyzed. Results Compared with that before treatment, the Titin-ab PIN values, the AchR-ab PIN values, and the PrsmR-ab P/N values of IA group were all decreased significantly after treatment (P<0.05, respectively). The P/N value of Titin-ab in IA group was decreased by 54.7%～3.5%, which was significantly higher than that in Ig group(19.9%±3.1%) (P<0.01). QMG score reduced by 42.4%± 4.2% and 23.8%±3.7% in IA group and Ig group respectively (P<0.01, respectively). Symptoms were effectively ameliorated by both treatments, but the effective power of IA group was higher than that of Ig group (70% vs 40%, P<0.05). Remission time of IA group was significantly shorter than that of Ig group [(5.38±0.42) d vs (8.4±1.54) d, P=0.008), so was the duration of in-hospital [(13.50±0.50) d vs (16.50±0.50) d, P<0.05). The number of respiratory support in IA group was less than that in Ig group (1/10 vs 6/15, P<0.05). By the Pearson correlation analysis, the decrease of Titin-ab showed a better longitudinal correlation with the decrease of QMG score than the other two antibodies (r=0.6315, P<0.01). Conclusion IA can rapidly and effectively clear the pathogenic antibodies of late-onset MG patients and its short-term clinical efficacy is better than immunoglobin.