Clinical Subtype Analysis Of Patients With Myasthenia Gravis Based On Antibody Typing

Objective:With the understanding of MG pathogenesis and antibody subtypes,the clinical characteristics of different subtypes of MG are different Therefore,the study analyzed the antibody titer,age of onset,sex,duration of disease,neostigmine test,low frequency RNS,thoracic imaging,Osserman classification,MGFA classificationinitial symptoms and treatment characteristics between AChR-MG,MuSK-MG,and DSN-MG It is intended to help clinical prediction and diagnosis of disease progression Methods:The study included 63 MG patients who visited Xi'an Gaoxin Hospital from January2013 to January 2019 51 patients were included excluded 12 patients without AChR-Ab,MuSK-Ab and impaired data The AChR-Ab and MuSK-Ab titers were determined by radioimmunoassay MG patients were divided into three groups based on antibodies:36patients in the AChR-MG,4 patients in the MuSK-MG,and 11 patients in the DSN-MG Data were statistically analyzed by using the analysis of variance,Mann Whiteny-U test,Kruskal-Wallis H rank sum test,Fisher's exact test,and Spearman rank correlation analysis Result:1 There were no significant differences in gender,disease duration,neostigmine test,RNS between AChR-MG,MuSK-MG and DSN-MG groups(P>0 05)2 The age of onset in AChR-MG and MuSK-MG group was larger than that in DSN-MG(P<0 05)There were significant differences in thymus abnormality(thymoma,thymus hyperplasia),modified Osserman classification and OMG/GMG classification among the three groups(P<0 05)3 There was a positive correlation between AChR-A titer and disease duration(r=0 427,P=0 002),and no correlation with age of onset(P>0 05)There was no correlation between MuSK-Ab titer and age and duration of disease(P>0 05)4 AChR-Ab titer was statistically significant(P<0 01)with thymus abnormalities and Low frequency RNS,statistically significant with OMG/GMG typing(P<0 05);MuSK-Ab titer and thymus abnormalities(thymoma,thymus hyperplasia),low frequency RNS,OMG/GMG There was no significant difference in typing and crisis(P>0 05)5 There were significant differences in AChR-Ab titer and MuSK-Ab titer between AChR-MG,MuSK-MG and DSN-MG(P<0 05)6 There was a statistically significant difference between AChR-MG and MuSK-MG and DSN-MG in facial nerve,accessory nerve and ulnar nerve RNS(P<0 01)There was no significant difference between the MuSK-MG and DSN-MG groups(P>0 05)The low frequency positive rate of three groups of accessory nerve low frequency RNS>facial nerve and ulnar nerve7 The first symptom of AChR-MG was mostly affected by eye involvement(66 67%),24 cases of medullary symptoms(66 67%),3 cases of muscle atrophy(1 case of lingual muscle and facial muscle atrophy,1 case of facial muscle atrophy,1 case of lingual muscle atrophy);MuSK-MG first occurred in 3 cases of ocular symptoms,1 case of limb weakness,Three of them developed medullary involvement(1 case of lingual muscle atrophy);DSN-MG group had the largest proportion of ptosis and diplopia(81 82%),and 3patients involved medulla within half a year8 17 cases of AChR-MG patients were treated with high-dose methylprednisolone shock treatment;4 cases of MuSK-MG could not improve ChEI,2 cases were improved after high-dose methylprednisolone shock treatment,and the disease relapsed after hormone reduction The efficacy of conventional immunosuppressive agents is not good,and the condition tends to be stable after treatment with RTX conclusion:1 The age of onset of AChR-MG and MuSK-MG was larger than that of DSN-MG;the abnormality of thymus in MuSK-MG was rare;the clinical classification and thymus abnormalities of AChR-MG,MuSK-MG and DSN-MG were statistically significant(P< 0 01)2 The first symptoms of AChR-MG group and DSN-MG group were more common in ocular involvement AChR-MG group and MuSK-MG group were more severe,medullary involvement was more,DSN-MG was milder;AChR-MG group and MuSKMuscle atrophy can occur in MG group;AChR-MG group is sensitive to ChEI and hormones,and our DSN-MG uses less hormone;MuSK-MG group is not sensitive to ChEI,two of the patients had poor effects on hormones and conventional immunosuppressive agents,and improved after RTX treatment3 The low-frequency positive rate of RNS in the three groups was higher than that in the facial nerve and ulnar nerve;The concentration of AChR-Ab was correlated with clinical classification.