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目的探讨重症肌无力(MG)患者的免疫指标与病情、分类及疗效之间的关系,评价其临床意义。方法在治疗前后动态采用流式细胞仪检测外周血CD3、CD4和CD8及比浊法检测IgG、IgA和IgM,进行分类比较其变化。结果全身型MG患者的IgG、IgA较眼肌型高,P<0.05,差异有统计学意义。在体液免疫低下组中,用丙种球蛋白治疗的缓解率为95.2%,仅用吡啶斯的明组缓解率为28.8%,二者比较差异有统计学意义(P<0.01)。CD4/CD8比值降低占48%,比值升高占24.4%,比值正常占27.6%。根据IgG、IgA、IgM的值进行分类,低下组占48.9%,升高组占20.4%,紊乱组占9.7%,正常组占21%。各免疫指标在治疗前后的比较差异无统计学意义,各免疫分组的临床资料比较差异也无统计学意义。结论MG患者的免疫状态比较复杂,以低下或抑制为主,还有相当比例在正常范围。IgG、IgA、IgM、CD3、CD4、CD8不能作为MG病情、疗效的惟一评价指标,但对指导治疗具有一定的参考价值。
Objective To investigate the relationship between the immune parameters of patients with myasthenia gravis (MG) and the disease, classification and therapeutic effect and to evaluate their clinical significance. Methods The changes of CD3, CD4 and CD8 in peripheral blood and IgG, IgA and IgM in turbidimetric method were detected by flow cytometry before and after treatment. Results The serum IgG and IgA in patients with systemic MG were significantly higher than those in ocular muscle (P <0.05). The difference was statistically significant. In low humoral immunity group, the remission rate was 95.2% with gamma globulin, and the remission rate with pyridostilon alone group was 28.8%. There was significant difference between the two groups (P <0.01). CD4 / CD8 ratio decreased 48%, the ratio increased 24.4%, the ratio of normal 27.6%. According to the values of IgG, IgA and IgM, the lower group accounted for 48.9%, the elevated group accounted for 20.4%, the disorder group 9.7% and the normal group 21%. There was no significant difference in each immune index before and after treatment, and there was no significant difference in the clinical data of each immunization group. Conclusion The immune status of patients with MG is more complicated, with low or suppressed, and a considerable proportion of the normal range. IgG, IgA, IgM, CD3, CD4, CD8 can not be used as MG disease, the only evaluation of efficacy, but the guidance of treatment has a certain reference value.