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目的探讨糖皮质激素(GC)对重症肌无力(MG)患儿外周血T细胞亚群、体液免疫的调控及其干预作用。方法 MG患儿40例作为MG组,同期健康儿童20例作为健康对照组。分别抽取MG组与健康对照组儿童外周静脉血,采用流式细胞术检测T细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+比例;ELISA法检测乙酰胆碱受体-抗体(AChR-Ab)水平;散射比浊法检测IgG、IgM、IgA、C3、C4和IgG亚群(IgG1、IgG2、IgG3、IgG4)水平。结果 MG组治疗前外周血CD3+T细胞百分率与健康对照组比较差异无统计学意义(t=1.36,P>0.05),CD4+T细胞百分率、CD4+/CD8+较健康对照组升高,CD8+T细胞百分率较健康对照组降低,差异均有统计学意义(Pa<0.01);MG组治疗前血清AChR-Ab阳性率为42.5%,IgG、IgM、IgA和C4、IgG2、IgG4与健康对照组比较差异均无统计学意义(Pa>0.05),IgG1、IgG3和C3均高于健康对照组,差异均有统计学意义(Pa<0.05);经3个月GC治疗,MG组治疗后的CD4+T细胞百分率、CD4+/CD8+比例较MG组治疗前明显下降,CD8+T细胞百分率则明显上升,差异均有统计学意义(Pa<0.01);MG组治疗后AChR-Ab阳性率下降到22.5%,IgG1较治疗前明显下降,差异有统计学意义(t=3.30,P<0.01)。结论 T细胞亚群失衡和IgG1、IgG3和C3异常参与儿童MG的发病。GC通过调控T淋巴细胞亚群比例,恢复其正常的Th/Ts平衡、抑制过强的细胞免疫应答、抑制MG患儿血清AChR-Ab亚群IgG1的产生,进而降低AChR-Ab水平,从而达到缓解MG患儿临床症状的目的。
Objective To investigate the regulation and intervention of glucocorticoid on peripheral blood T lymphocyte subsets and humoral immunity in children with myasthenia gravis (MG). Methods 40 cases of MG children as MG group, 20 cases of healthy children at the same period as a healthy control group. Peripheral venous blood was collected from MG group and healthy control group respectively. The proportion of CD3 +, CD4 +, CD8 + and CD4 + / CD8 + of T lymphocyte subsets was detected by flow cytometry. The level of AChR-Ab was detected by ELISA. The levels of IgG, IgM, IgA, C3, C4 and IgG subgroups (IgG1, IgG2, IgG3, IgG4) were determined by turbidimetry. Results There was no significant difference in the percentage of CD3 + T cells in MG before treatment (t = 1.36, P> 0.05). The percentage of CD4 + T cells and CD4 + / CD8 + in MG group were significantly higher than those in healthy controls (P <0.01). The positive rate of serum AChR-Ab in MG group was 42.5%, IgG, IgM, IgA and C4, IgG2 and IgG4 were significantly higher than those in healthy control (Pa> 0.05). The levels of IgG1, IgG3 and C3 were significantly higher in patients with MG than those in healthy controls (Pa0.05). After 3 months GC treatment, CD4 (P <0.01). The positive rate of AChR-Ab in MG group decreased to 22.5 after treatment (P <0.01), while the percentage of CD4 + / CD8 + %, IgG1 than before treatment decreased significantly, the difference was statistically significant (t = 3.30, P <0.01). Conclusion The unbalance of T cell subsets and the abnormality of IgG1, IgG3 and C3 are involved in the pathogenesis of childhood MG. GC regulates the proportion of T lymphocyte subsets, restores its normal Th / Ts balance, suppresses excessive cellular immune response, inhibits the production of AChR-Ab subgroup IgG1 in serum of MG children, and then decreases the level of AChR-Ab Alleviates the clinical symptoms of MG children purpose.