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目的探讨乙酰胆碱受体抗体(AChR-Ab)与重症肌无力(MG)临床特征的相关性。方法采用放射免疫法检测115例MG患者及92例对照组(非MG神经系统疾病患者42例,健康体检者50名)血清AChRAb浓度,应用临床绝对评分记录MG患者病情严重程度。分析各组血清AChR-Ab浓度的差异,以及AChR-Ab浓度与MG患者临床特征的相关性。采用ROC工作特征曲线探讨AChR-Ab诊断MG的敏感度和特异度。结果MG患者血清AChR-Ab浓度中位数(四分位数间距,下同)为3.45(39.38)nmol/L,较非MG神经系统疾病患者[0(0)nmol/L]和健康体检者[0(0)nmol/L]增高(P<0.01)。全身型MG(GMG)患者AChR-Ab浓度[25.45(46.14)nmol/L]较眼肌型MG(OMG)患者[0.58(3.56)nmol/L]增高(P<0.01)。用ROC曲线法分析显示,以血清AChR-Ab浓度≥0.50nmol/L作为诊断MG界值时灵敏度为72.17%,特异度为100%,曲线下面积(AUC)=0.895(95%CI:0.849~0.941)。AChR-Ab浓度与发病年龄、病程及改良Osserman分型呈正相关(r=0.220,P<0.05;r=0.184,P<0.05;r=0.382,P<0.01),但相关性较弱(均r<0.5),与临床绝对记分无相关性(r=0.147,P>0.05)。结论用放射免疫法检测血清AChR-Ab浓度诊断MG的灵敏度和特异度均高,有助于减少MG的漏诊率及误诊率,值得临床推广。
Objective To investigate the relationship between AChR-Ab and myasthenia gravis (MG). Methods Radioimmunoassay was used to detect serum AChRAb concentrations in 115 MG patients and 92 control patients (42 non-MG nervous system diseases and 50 healthy subjects). The clinical severity score was recorded by clinical absolute score. The difference of serum AChR-Ab concentration in each group was analyzed, and the correlation between AChR-Ab concentration and clinical features of MG was analyzed. The sensitivity and specificity of AChR-Ab in the diagnosis of MG were studied using ROC operating characteristic curves. Results The median serum AChR-Ab concentration in patients with MG was 3.45 (39.38) nmol / L, which was significantly higher than that in non-MG patients (0 (0) nmol / L) [0 (0) nmol / L] increased (P <0.01). The concentration of AChR-Ab in patients with systemic MG (GMG) [25.45 (46.14) nmol / L] was significantly higher than that in patients with OMG (0.58 (3.56) nmol / L, P <0.01). The ROC curve analysis showed that the sensitivity, specificity and specificity of the AChR-Ab concentration ≥0.50nmol / L were 72.17%, 100% respectively. The area under the curve (AUC) was 0.895 (95% CI: 0.849 ~ 0.941). There was a positive correlation between AChR-Ab concentration and age, course of disease and Osserman classification (r = 0.220, P <0.05; r = 0.184, P <0.05; r = 0.382, P <0.01) <0.5). There was no correlation with clinical absolute score (r = 0.147, P> 0.05). Conclusion The sensitivity and specificity of detecting the serum AChR-Ab concentration by radioimmunoassay are both high and helpful to reduce the misdiagnosis rate and misdiagnosis rate of MG, which is worthy of clinical promotion.