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目的 探讨重症肌无力 (MG)发病的内分泌机制。方法 应用固相放射免疫一步法和酶联免疫吸附法检测 37例 (男 /女 =18/19,以下同 )MG患者、2 3例 (12 /11)其他自身免疫性神经疾病患者、2 4例 (14/10 )非脑卒中的其他神经系统疾病患者和 36名 (17/19)正常人的血清睾酮 (Te)、雌二醇 (E2 )水平及乙酰胆碱受体抗体 (AChRAb)滴度。结果 (1)MG患者有性激素失衡 ,表现为Te/E2 对数值下降 ,但机制有别 ,女性MG患者是血清E2 水平绝对值增高所致 ,男性MG患者是血清Te、E2 同时下降所致。 (2 )MG患者的病型与性激素失衡相关。MG Ⅱ型较MG Ⅰ型患者血清E2 水平升高和Te/E2 对数值下降更明显 ;但与许氏临床绝对计分之间无相关关系 ;提示性激素与MG受累肌群不同有影响 ,而与MG的肌无力严重程度无关。 (3)女性MG患者血清AChRAb滴度与性激素失衡有关 ,抗体阳性组血清E2 水平升高 ,Te/E2 对数值下降。但两组男性MG患者差异未见显著意义。结论性激素紊乱可能是破坏MG患者免疫自身稳定性的因素之一 ,并与MG发病 (尤于女性患者 )有关。
Objective To investigate the pathogenesis of myasthenia gravis (MG). Methods 37 patients with MG (male / female = 18/19, the same below) and 23 (12/11) other autoimmune neurological diseases were detected by solid phase radioimmunoassay and enzyme-linked immunosorbent assay Serum testosterone (Te), estradiol (E2) levels and acetylcholine receptor antibody (AChRAb) titers were measured in 14 (14/10) non-stroke patients with other neurological diseases and 36 (17/19) normal subjects. Results (1) The imbalance of sex hormones was observed in patients with MG, showing a decrease in Te / E2 logarithm, but the mechanisms were different. The absolute value of serum E2 was increased in female patients with MG. Serum Te and E2 were also decreased in male patients with MG. (2) MG patients with sex hormone imbalance and disease-related. Serum E2 level and Te / E2 log decreased more obviously in patients with MG Ⅱ type than those with MG Ⅰ type, but had no correlation with clinical absolute score of Hsü, suggesting that sex hormones had different effects on the muscle group affected by MG, MG has nothing to do with the severity of muscle weakness. (3) Serum AChRAb titer in women with MG was related to imbalance of sex hormones. Serum E2 level of antibody positive group was decreased and Te / E2 logarithm was decreased. However, there was no significant difference between the two groups of male patients with MG. Conclusions Sex hormonal disorders may be one of the factors that undermine the self-stability of immunity in patients with MG and are related to the pathogenesis of MG (especially in female patients).