發(fā)布時(shí)間：2018-06-05 05:21

  本文選題：重癥肌無(wú)力 + 自身免疫抗體　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本課題通過(guò)分析重癥肌無(wú)力(Myasthenia Gravis,MG)患者的病例資料,以及免疫相關(guān)指標(biāo)檢測(cè)結(jié)果,旨在探討各免疫指標(biāo)在MG發(fā)病中的作用。方法:病例資料收集:從2012年1月到2017年1月期間在廣西醫(yī)科大學(xué)第一附屬醫(yī)院住院并已確診為MG的56例病人的病例資料作為病例組,與MG組年齡匹配的沒(méi)有自身免疫疾病的健康者的30例血清免疫相關(guān)檢測(cè)指標(biāo)資料作為對(duì)照組,比較兩組的自身免疫抗體組合檢測(cè)、T細(xì)胞亞群、CD4/CD8細(xì)胞計(jì)數(shù)、甲功和甲狀腺抗體、腫瘤標(biāo)記物、抗O及類(lèi)風(fēng)濕因子、空腹血糖、餐后2小時(shí)血糖、糖化血紅蛋白等各指標(biāo)。此外分析眼肌型和全身型MG的各免疫指標(biāo)并進(jìn)行統(tǒng)計(jì)分析。結(jié)果:MG組中衰減試驗(yàn)陽(yáng)性率為48.21%(27/56)、疲勞試驗(yàn)陽(yáng)性率89.29%(50/56)、新斯的明試驗(yàn)陽(yáng)性率80.36%(45/56)。MG組的自身免疫抗體(X~2=7.471,P=0.006)、腫瘤標(biāo)記物(X~2=8.205,P=0.004)陽(yáng)性率高于對(duì)照組,合并甲狀腺功能異常(X~2=8.958,P=0.003)、合并糖尿病(X~2=4.082,P=0.043)發(fā)生率高于對(duì)照組,而合并其他免疫疾病(X~2=2.247,P=0.134)、合并胸腺瘤(X~2=3.455,P=0.063)的發(fā)生率及ASO(X~2=0.542,P=1.000)、RF(X~2=1.097,P=0.295)的水平較對(duì)照組高,但無(wú)統(tǒng)計(jì)學(xué)意義。MG組的FT3(P=0.000)、非小細(xì)胞肺癌抗原(P=0.002)、神經(jīng)元特異性烯醇化酶NSE(P=0.002)、餐后2小時(shí)血糖(P=0.036)、糖化血紅蛋白(P=0.000)、CD4+T細(xì)胞(%)(P=0.003)、CD4/CD8(P=0.001)的水平較對(duì)照組高,而TSH(P=0.001)的水平較對(duì)照組低,差異具有統(tǒng)計(jì)學(xué)意義。全身型MG患者的抗自身免疫抗體中:抗RO-52抗體(X~2=0.659,P=0.417)、抗核抗體(Ig G型)ANA(X~2=1.12,P=0.578)和免疫熒光ANA:顆粒型(X~2=0.806,P=1.000)的陽(yáng)性率及甲功異常(X~2=0.006,P=0.936)、衰減試驗(yàn)(X~2=0.009,P=0.926)、疲勞試驗(yàn)(X~2=8.485,P=0.107)和新斯的明試驗(yàn)(X~2=0.249,P=0.511)的陽(yáng)性率均較眼肌型高,但無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:MG發(fā)病與自身免疫抗體、腫瘤標(biāo)記物、甲狀腺功能異常、糖尿病相關(guān),其中FT3、非小細(xì)胞肺癌抗原、NSE、餐后2小時(shí)血糖、糖化血紅蛋白、CD4/CD8和CD4+T細(xì)胞(%)水平在MG患者中較高,而TSH水平較低。
[Abstract]:Objective: by analyzing the data of patients with myasthenia gravis (MGG) and the results of immune-related indexes, the purpose of this study was to explore the role of immune indexes in the pathogenesis of myasthenia gravis (MG). Methods: case data were collected from 56 patients who were hospitalized in the first affiliated Hospital of Guangxi Medical University from January 2012 to January 2017. The serum immune-related indexes of 30 healthy subjects without autoimmune disease matched with the age of MG group were used as the control group. The T cell subsets CD4 / CD8 cell count, thyroid antibody and thyroid antibody were detected by the combination of autoimmune antibodies in the two groups. Tumor markers, anti-O and rheumatoid factors, fasting blood glucose, 2 hours postprandial blood glucose, glycosylated hemoglobin and so on. In addition, the immune indexes of myometrial and systemic MG were analyzed and analyzed statistically. Results the positive rates of attenuation test and fatigue test were 48.21 / 27 / 56, 89.29 and 50 / 56, respectively. The positive rate of autoimmune antibody (XG) 27.471 (P0. 006) and tumor marker (XG 28.205P0.004) in the 80.36%(45/56).MG group was higher than that in the control group. The incidence of the patients with abnormal thyroid function was higher than that of the control group, but the incidence of the patients with other immune diseases was higher than that of the control group, and the incidence rate of the patients with Thymoma was 3.455P0.063), and the level of ASOOX20.542P1.000 was higher than that of the control group (P < 0.05), but the incidence of the disease was higher than that of the control group, and the incidence of the patients with the disease was higher than that of the control group, and the incidence of the disease was higher than that of the control group. However, no statistical significance was found in the levels of FT3P0. 000, P0. 002, NSEP0. 002, NSEP0. 002, P0. 036, P0. 000, P0. 000, CD4, CD8, P0. 001), but the levels of TSHP0. 001) were significantly higher in MG group than in the control group, but the levels of TSHP0. 001) were lower than those in the control group, but the levels of P0. 003- CD8 + P0. 001) were significantly lower than those in the control group (P < 0. 003, P < 0. 003), but the levels of TSHP0.001) were lower than those in the control group. The difference is statistically significant. The positive rate of anti-autoimmune antibodies in patients with systemic MG: anti RO-52 antibody X20.659P0. 417, antinuclear antibody ANAG X21.12P0. 578) and immunofluorescence Ana: ANAA: X2: 0. 806P1. 000) positive rate and the positive rate of thyroid dysplasia X20.006 / P0. 936, attenuation test X220.009 P0. 026, fatigue test X28.485P0. 107) and Xinsi test X2 0. 249P0. 11) The rate was higher than that of ocular muscle type. But there is no statistical significance. Conclusion the incidence of microglobulin is associated with autoimmune antibodies, tumor markers, thyroid dysfunction and diabetes mellitus. The levels of FT3, NSE, 2-hour postprandial blood glucose, glycosylated hemoglobin CD _ 4 / CD _ 8 and CD4 T cells are higher in MG patients. The level of TSH was lower.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R746.1

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本文編號(hào)：1980740