重症肌无力与甲状腺异常的相关性
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摘要
目的：研究重症肌无力(MG)与甲状腺异常的相关性，分析两者经常共同伴发的原因，探讨两种疾病的密切联系。进一步研究影响MG和甲状腺异常的相关抗体血清浓度之间的关系，分析血清AChRAb~+TRAb~+双阳性MG的临床表现特点。
方法：首先检测100例MG血清甲状腺功能，即游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)。同时还检测了甲状腺抗体，即促甲状腺激素受体抗体(TRAb)、甲状腺球蛋白抗体(TGAb)和甲状腺微粒体抗体(TMAb)。比较这组MG甲状腺功能和甲状腺抗体异常率的差异，探讨其原因。接着，进一步检测32例MG血清乙酰胆碱受体抗体(AChRAb)、促甲状腺激素受体抗体(TRAb)、甲状腺球蛋白抗体(TGAb)和甲状腺微粒体抗体(TMAb)的浓度。研究AChRAb与TRAb、TGAb和TMAb的相关性，即AChRAb和TRAb、AChRAb和TGAb、AChRAb和TMAb血清浓度有无线性关系。将32例MG分成两组，AChRAb~+ TRAb~+组和非双抗体阳性组，比较两组MG的MGFA临床分型和首次发病年龄段与抗体的关系。将其中的Ⅱ型MG 14例分成两组：AChRAb~+ TRAb~+组和非双抗体阳性组，比较两组临床首发症状与抗体的关系。
结果：对100例MG血清甲状腺激素和甲状腺抗体的研究显示，甲亢或甲减者16例(16％)，甲状腺抗体检查阳性者71例(71％)。甲状腺抗体阳性比例高于甲状腺功能阳性比例(X~2=4．788，P<0．05)。对32例MG血清两类抗体的研究显示，MG血清AChRAb与TRAb浓度存在线性相关(r=0．609，P=0．0002)，而AChRAb与TGAb、TMAb不存在线性相关(P>0．05)。通过统计学计算，AChRAb~+TRAb~+组与非双抗体阳性组在临床分型上未见明显差异(P>0．05)。AChRAb~+TRAb~+组在发病年龄上可能早于非双抗体阳性组，但无统统计学差异。对Ⅱ型MG患者的分析表明，AChRAb~+TRAb~+MG多以眼外肌无力为首发症状(P<0．05)。
结论：本研究认为，MG患者出现甲状腺抗体异常比出现甲亢或甲减更多见，提示MG相关抗体与甲状腺抗体之间可能存在免疫交叉反应。MG血清AChRAb与TRAb浓度存在线性相关，AChRAb~+TRAb~+MG多是以眼外肌无力为首发症状，提示可能与相似的免疫遗传机制有关。
PURPOSE: To study the relationship of myasthenia gravis and thyroid abnormal. To study the relationship between the AChR antibody and the thyroid related antibodies of myasthenia gravis patients, and to study the clinical features of MG with AChRAb~+TRAb~+.
METHODS: First, thyroid function, and thyroid antibodies of 100 MG patients were observed, FT3, FT4, TSH and TRAb, TGAb, TMAb were detected. Then, samples in our study came from 32 MG patients, the AChRAb, TRAb, TGAb and TMAb were measured, the linear relationship between AChRAb and TRAb, AChRAb and TGAb, AChRAb and TMAb were observed. The 32 MG patients were divided into two groups, AChRAb~+TRAb~+ group and non-AChRAb~+TRAb~+ group, and their MGFA clinical classification (according to the standard) and age of MG occurence were compared. To the subtypeⅡMG patients, 14 MG patients were divided into two groups, AChRAb~+TRAb~+ group and non-AChRAb~+TRAb~+ group, their first symptoms were compared.
RESULTS: Among the 100 MG patients, there were 16 % of them were hyperthyroidism or hypothyroidism, and there were 71 % of the samples were detected out positive thyroid antibody. MG patients with thyroid positive antibody are much more than those with hyperthyroidism and hypothyroidism (X~2 = 4.788, P<0.05) . A linear correlation between AChRAb and TRAb was proved (r=0.609, P=0.0002) . But neither AChRAb and TGAb, nor AChRAb and TMAb showed this relationship (P>0.05) . Between AChRAb~+TRAb~+ group and non-AChRAb~+TRAb~+ group, no significant difference on the clinical classification was found (P>0.05) . Maybe the age of onset was earlier in MG patients with AChRAb~+TRAb~+ than those non-AChRAb~+TRAb~+, but it was still lack of evidence on statistics .To the MG subtypeⅡ, AChRAb~+TRAb~+ MG patients were most likely to present oclular muscle weakness firstly (P<0.05) .
CONCLUSIONS: The incidence of MG patients with thyroid related antibody is much higher than that MG with hyperthyroidism and hypothyroidism , it suggests that there is a cross immunoreaction between the MG related antibody and the thyroid antibody. In MG, there is a linear correlation between AChRAb and TRAb. AChRAb~+TRAb~+ MG mainly present ocular muscle weakness first.
方法：首先检测100例MG血清甲状腺功能，即游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)。同时还检测了甲状腺抗体，即促甲状腺激素受体抗体(TRAb)、甲状腺球蛋白抗体(TGAb)和甲状腺微粒体抗体(TMAb)。比较这组MG甲状腺功能和甲状腺抗体异常率的差异，探讨其原因。接着，进一步检测32例MG血清乙酰胆碱受体抗体(AChRAb)、促甲状腺激素受体抗体(TRAb)、甲状腺球蛋白抗体(TGAb)和甲状腺微粒体抗体(TMAb)的浓度。研究AChRAb与TRAb、TGAb和TMAb的相关性，即AChRAb和TRAb、AChRAb和TGAb、AChRAb和TMAb血清浓度有无线性关系。将32例MG分成两组，AChRAb~+ TRAb~+组和非双抗体阳性组，比较两组MG的MGFA临床分型和首次发病年龄段与抗体的关系。将其中的Ⅱ型MG 14例分成两组：AChRAb~+ TRAb~+组和非双抗体阳性组，比较两组临床首发症状与抗体的关系。
结果：对100例MG血清甲状腺激素和甲状腺抗体的研究显示，甲亢或甲减者16例(16％)，甲状腺抗体检查阳性者71例(71％)。甲状腺抗体阳性比例高于甲状腺功能阳性比例(X~2=4．788，P<0．05)。对32例MG血清两类抗体的研究显示，MG血清AChRAb与TRAb浓度存在线性相关(r=0．609，P=0．0002)，而AChRAb与TGAb、TMAb不存在线性相关(P>0．05)。通过统计学计算，AChRAb~+TRAb~+组与非双抗体阳性组在临床分型上未见明显差异(P>0．05)。AChRAb~+TRAb~+组在发病年龄上可能早于非双抗体阳性组，但无统统计学差异。对Ⅱ型MG患者的分析表明，AChRAb~+TRAb~+MG多以眼外肌无力为首发症状(P<0．05)。
结论：本研究认为，MG患者出现甲状腺抗体异常比出现甲亢或甲减更多见，提示MG相关抗体与甲状腺抗体之间可能存在免疫交叉反应。MG血清AChRAb与TRAb浓度存在线性相关，AChRAb~+TRAb~+MG多是以眼外肌无力为首发症状，提示可能与相似的免疫遗传机制有关。
PURPOSE: To study the relationship of myasthenia gravis and thyroid abnormal. To study the relationship between the AChR antibody and the thyroid related antibodies of myasthenia gravis patients, and to study the clinical features of MG with AChRAb~+TRAb~+.
METHODS: First, thyroid function, and thyroid antibodies of 100 MG patients were observed, FT3, FT4, TSH and TRAb, TGAb, TMAb were detected. Then, samples in our study came from 32 MG patients, the AChRAb, TRAb, TGAb and TMAb were measured, the linear relationship between AChRAb and TRAb, AChRAb and TGAb, AChRAb and TMAb were observed. The 32 MG patients were divided into two groups, AChRAb~+TRAb~+ group and non-AChRAb~+TRAb~+ group, and their MGFA clinical classification (according to the standard) and age of MG occurence were compared. To the subtypeⅡMG patients, 14 MG patients were divided into two groups, AChRAb~+TRAb~+ group and non-AChRAb~+TRAb~+ group, their first symptoms were compared.
RESULTS: Among the 100 MG patients, there were 16 % of them were hyperthyroidism or hypothyroidism, and there were 71 % of the samples were detected out positive thyroid antibody. MG patients with thyroid positive antibody are much more than those with hyperthyroidism and hypothyroidism (X~2 = 4.788, P<0.05) . A linear correlation between AChRAb and TRAb was proved (r=0.609, P=0.0002) . But neither AChRAb and TGAb, nor AChRAb and TMAb showed this relationship (P>0.05) . Between AChRAb~+TRAb~+ group and non-AChRAb~+TRAb~+ group, no significant difference on the clinical classification was found (P>0.05) . Maybe the age of onset was earlier in MG patients with AChRAb~+TRAb~+ than those non-AChRAb~+TRAb~+, but it was still lack of evidence on statistics .To the MG subtypeⅡ, AChRAb~+TRAb~+ MG patients were most likely to present oclular muscle weakness firstly (P<0.05) .
CONCLUSIONS: The incidence of MG patients with thyroid related antibody is much higher than that MG with hyperthyroidism and hypothyroidism , it suggests that there is a cross immunoreaction between the MG related antibody and the thyroid antibody. In MG, there is a linear correlation between AChRAb and TRAb. AChRAb~+TRAb~+ MG mainly present ocular muscle weakness first.
引文
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