胸腺切除术后应用免疫抑制剂治疗重症肌无力的分析研究.docVIP

胸腺切除术后应用免疫抑制剂治疗重症肌无力的分析研究 　　作者：乞国艳,郑旭光,杨红　　作者单位：河北省石家庄市第一医院肿瘤科(乞国艳、杨红、郄春菊、刘慈、顾姗姗)，心胸外科(郑旭光、张太明 　　【摘要】目的探讨重症肌无力患者胸腺切除术后应用免疫抑制剂治疗的CD4+CD25+Tr细胞百分率和乙酰胆碱受体抗体的变化。方法 A组(n=34)重症肌无力患者胸腺切除术后应用免疫抑制剂组;B组(n=35)重症肌无力患者胸腺切除后未应用免疫抑制剂组;用流式细胞仪计数外周血A、B 2组治疗前和治疗后6个月的CD4+CD25+Tr细胞的百分率和酶联免疫吸附法检测乙酰胆碱受体抗体(AchRAb)，应用许氏临床评分法对病情的严重程度和转归进行评定。结果 A、B 2组比较CD4+CD25+Tr细胞百分率、乙酰胆碱受体抗体(AchRAb)、临床相对计分在治疗后6个月差异有统计学意义(P0.01)。结论 HTK胸腺切除后应用免疫抑制剂6个月后，重症肌无力患者的CD+4 CD+25Tr细胞的百分率明显增高和AchRAb明显降低，肌无力症状稳定缓解。 　　【关键词】 重症肌无力;CD4+CD25+Tr细胞(调节性 T 细胞);免疫抑制剂;乙酰胆碱受体抗体 　　Clinical observation for the treatment of myasthenia gravis with immunosuppressive agents after thymusectomy QI Guoyan*,ZHENG Xuguang,YANG Hong*，et al.*Department of Oncology,The Frist Hospital of Shijiazhuang City,Shijiazhuang 050011,China 　　【Abstracts】 Objective To obseve the changes of CD4+CD25+Tr cell and AchRAb in the treatment of myasthenia gravis (MG) with immunosuppressive agents after thymusectomy.Mathods 34 patients with myasthenia gravis in group A were treated with immunosuppressive agents after thymusectomy,however,the other 35 patients in group B were not treated with immunosuppressive agents after thymusectomy.The CD+4 CD+25Tr percentage before treatment and after 6-month treatment was detected by flow cytometry,and AchRAb from peripheral blood was determined by ELISA.The clinical severity and prognosis of MG were evaluated by Xus clinical scoring system.Results After 6-month treatment there were significant difference in CD+4 CD+25Tr percentage,AchRAb and clinical relative score between group A and group B(P0.01).Conclusion The CD+4 CD+25Tr percentage is obviously increased after 6month treatment with immunosuppressive agents after thymusectomy. 　　【Key words】 myasthenia gravis;CD4+CD25+Tr cell(regulation T cell);immunosuppressive agents;AchRAb 　　重症肌无力(myasthenia gravis,MG)是神经肌肉接头处传递功能障碍的疾病，是由乙酰胆碱受体抗体介导、T细胞依赖、补体参与的自身免疫性疾病,细胞免疫免疫调节异常是本病的重要的发病机制之一[1，2]。我们利用流式细胞仪检测2组MG患者的外周血T细胞亚群CD+4CD+25Tr细胞的百分率和乙酰胆碱受体抗体(AchR