| Objective:Myasthenia gravis is an acquired autoimmune disease with neuromuscular junction transmission disorder.The main clinical manifestations are that skeletal muscle is prone to fatigue,symptoms are aggravated after activity,and symptoms are significantly alleviated after rest and treatment with cholinesterase inhibitors.Although the current treatment plan has been very mature,the therapeutic effect of some patients is not satisfactory.The purpose of this study is to find biomarkers related to the severity of the disease and new treatment targets.Methods:This study included 50 patients with systemic myasthenia gravis who were diagnosed for the first time in the Department of Neurology of the first Hospital of Shanxi Medical University from September 2020 to September 2022.The general data,clinical data and serum of the patients were collected.The differential proteins were screened by ELISA method and protein chip technology and analyzed by bioinformatics.The changes of AChR antibodies and cytokines in patients with systemic myasthenia gravis were compared.The correlation between the score of clinical scale and clinical scale was analyzed.MG patients were divided into three groups(ELT classification): early onset MG(EOMG): onset age ≤49 years without thymoma;Late onset MG(LOMG): ≥50 years old,no thymoma;Thymoma-associated MG(TAMG): All age groups with thymoma.Results:1.The MG-ADL score,QMG score and MG-qol 15 score of the patients with systemic MG were lower than those of the first visit.The patients with MG were divided into TAMG group,EOMG group and LOMG group for subgroup analysis.It was found that MG-ADL score,QMG score,MG comprehensive score and MG-qol 15 score at revisit were lower than those at the first visit,and some of them had no statistical difference.2.The AChR-Ab concentration in MG patients was higher than that in the re-visit group.The MG patients were divided into TAMG group,EOMG group and LOMG group to analyze the changes of AChR-Ab concentration.The AChR-Ab concentration of patients in EOMG group and LOMG group was higher than that in re-visit group at the first visit,and there was no statistical difference between the AChR-Ab concentration of patients in TAMG group at the first visit and the re-visit group.3.By comparing the differential expression of cytokines between the primary diagnosis group and the re-diagnosis group of systemic MG,three differentially expressed cytokines were screened,which were BAFF,CD40 L and BLC,in which BAFF and CD40 L were down-regulated and BLC was up-regulated.4.The correlation study between AChR-Ab concentration and cytokine level at initial diagnosis and clinical correlation scale score found that IL-6 and IL-10 levels were significantly positively correlated with MG-ADL score in the correlation analysis at initial diagnosis.BAFF,IL-6 and IL-10 were positively correlated with QMG scores.BAFF,IL-6and IL-10 were positively correlated with MG scores.IL-6,IL-10 and BLC levels were positively correlated with MG-qol15 scores.There was no significant correlation between AChR-Ab,6Ckine,CD40,CD40 L,TNF-α,IFNβ,IFNγ,IL-1α,IL-1β,IL-17,IL-21,IL-23 and MG-ADL score,QMG score,MG composite score,and MG-QOL15 score.In the analysis of correlation between AChR-Ab and cytokine level changes and clinical correlation scale scores,no correlation was shown.There was no significant correlation between ΔAChR-Ab,Δ6ckine,ΔIL-6,ΔBAFF,ΔCD40,ΔCD40L,ΔIFNβ,ΔIFNγ,ΔIL-1α,ΔIL-1b,ΔIL-10,ΔIL-17,ΔIL-21,ΔIL-23,ΔTNFα,ΔBl C and ΔMG-ADL scores and ΔQMG score,ΔMG comprehensive score and ΔMG-QOL 15 score.Conclusion:1.Patients with systemic MG had improved clinical symptoms after treatment,and MG-ADL score,QMG score and MG-QOL 15 score were significantly decreased in the overall and subgroup analysis.2.AChR-Ab,BAFF,CD40 L and BLC are biomarkers associated with disease severity and targeted therapy,and are expected to become new therapeutic targets.3.AChR-Ab and cytokine levels could not reflect disease severity or predict prognosis. |
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