Role Of CD4~+ CD2~+ Tregulatory Cells To Clinical Outcome Of Ocular Myasthenia Gravis In Adult

Objective: Acquired myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction in which patients experience fluctuating skeletal muscle weakness that often affects selected muscle groups preferentially. The target of the autoimmune attack in most cases is the skeletal muscle acetylcholine receptor (AChR).About half of patients with MG present with visual complaints of droopy eyelids or double vision, and many will not remain with purely ocular muscle weakness with generalized weakness, defined as OMG. Patients may derive relief from nonpharmacologic interventions and cholinesterase inhibitors, but most will desire better symptom control with corticosteroids or need other immunosuppression. the pathogenesis and the outcome of OMG remains enigmatic. Regulatory T cells control immune responses to self- and foreign-antigens and play a major role in maintaining the balance between immunity and tolerance. It may be the important factor to outcome of ocular myasthenia gravis. The purpose of this study was to investigate the prognostic associated with the Clinical Outcome from ocular myasthenia gravis to generalized myasthenia gravis in adult.Method:The clinical data of 148 patients with MG.who were Diagnosised in the Outpatient and ward of anhui provincial hospital between Jan 2004 and Mar 2009.With the diagnosis date as a start point and the date OMG progressed to GMG as an end point.71 patients were males and 77 were females,and the patient's age ranging from 14-72 ,the mean gae is 38.81±14.62.In addition,these patients Were divided into the progressing team(74 cases)and the non-progressing groups(67 eases).And 7 patients was lost to the study . We examined various CD4~+CD25~+Treg in peripheral blood mononuclear cells using flow cytometry in a patient suffering from ocular myasthenia gravis. A total of 6 factors including age,sex,steroid, immunosuppressant,thymoma or thymic hyperplasia and the Percentage of CD4~+CD25~+Treg in CD4~+ Tcell were analyzed and calculated for the independent progress risk factors using the Cox logistic regression multivariate model.Results:The outcome was associated with 2 independent factors; Percentage of CD4~+CD25~+Treg in CD4~+ Tcell[95% CI (0.73-0.91),p<0.01] Immunosuppressant [95% CI (0.25-0.96) P=0.038] , These factors maybe improveded the outtcome of OMG .and the Percentage of CD4~+CD25~+Treg cells in CD4~+ Tcell was correlated with the time OMG progressed to GMG with partial mode(p<0.05) .Conclusion: Dysfunction of CD4~+CD25~+Treg has been demonstrated to play an important role in the development of autoimmune myasthenia gravis. This T cell subset, which has potent regulatory properties against immune response, has been reported to have a numerical or functional defect in patients with OMG. Which may .impassioned the progress,long-term azathioprine seems adequate to achieve remission in OMG patients.