The Influence Of Lymphoplasmapheresis Therapy On CD4~+T Cell Subgroups Of Patients With Myasthenia Gravis

Objective:This study is aimed to evaluate the efficacy of Lymphoplasmapheresis (LPE) therapy on CD4+T cell subset in patients with myasthenia gravis (MG), discuss immune mechanism of LPE in MG therapy and provide a theoretical basis for clinical therapy of MG, by testing serum concentration of anti-AchR antibody and peripheral blood (PB) frequency of Thl, Th2, Th17and Treg cells before and after LPE therapy and analyzing the association of changes between LPE therapy and CD4+T cell subset.Methods:A total of14MG patients underwent LPE therapy and14healthy controls were reviewed. The level of anti-AChR-Ab from collected PB in MG group was evaluated using ELISA. The PB frequent of Thl, Th2, Th17and Treg cells was tested by Flow Cytometer. The correlation among these indexes was observed at the same time. And QMG score was examined before and after LPE therapy. All the experimental data was analyzed using SPSS17.0software package.Results:(1)The score of QMG in MG patients after2days of LPE therapy (9.70±3.62) was obviously lower than that before therapy (18.50±3.47), and the difference was statistically significant (p<0.05).(2)2days after LPE therapy, the level of PB AChR-Ab (142±59pmol/l) in MG patients was obviously lower than that before therapy(258±74pmol/l), and the difference was statistically significant (p<0.05).(3)Before LPE therapy, Thl cells frequency in MG patients(25.64±7.23%)was higher than that in healthy controls (16.51±5.03%), and the difference was statistically significant (p<0.05); Thl cells frequency in MG patients after3days of LPE therapy (20.72±4.15%) was lower than that before therapy(25.64±7.23%)but higher than that in healthy controls(16.51±5.03%), and the difference was statistically significant (p<0.05). However, there was no statistic difference of Th2cells frequent between MG patients before LPE therapy and healthy controls, P>0.05. Though Th2cells frequency in MG patients after3days of LPE therapy was higher than that before therapy, there was no statistic difference between them, P>0.05. Before LPE therapy, Th17cells frequency in MG patients (2.05±0.51%) was higher than that in healthy controls(0.94±0.23), and the difference was statistically significant (p<0.05); Th17cells frequency in MG patients after3days of LPE therapy(1.18±0.36%) was lower than that before therapy (2.05±0.51%), P<0.05, but there was no statistic difference (P>0.05) compared with healthy controls. Before LPE therapy, Treg cells frequency in MG patients (2.16±0.73%) was lower than that in healthy controls(4.26±0.82%), and the difference was statistically significant (p<0.05); Treg cell frequency in MG patients after3days of LPE therapy(3.37±0.75%) was higher than that before therapy(2.16±0.73%), but lower than that in healthy controls(4.26±0.82%), and the difference was statistically significant (p<0.05)(4)Each time, LPE therapy could replace almost2-3×109PMBCs. There was no significant difference between Th1, Th2, Th17and Treg cells frequency in LPE liquid and that in PB of MQ resulting from Flow Cytometer, P>0.05.(5)The PB Thl, Th2, Th17, Treg cells frequency was conducted respectively by correlation analysis compared with clinical scoring. Results showed that both Thl and Th2cells frequent in MG patients before LPE therapy were positively correlated to clinical scoring (respectively r=0.602, r=-0.583, P<0.05). Treg cells frequency was negatively correlated to clinical scoring, r=-0.536, P<0.05; While, Th2cells frequency had no correlation with clinical scoring, r=0.248, P>0.05.(6)3days after LPE therapy, the PB Th1, Th2, Th17, Treg cells frequency was conducted respectively by correlation analysis compared with clinical scoring. Results showed that Th1, Th2, Th17and Treg cells frequency had no correlation with clinical scoring, respectively r=0.412, r=-0.306, r=0.541, r=-0.483, P>0.05.(7)3days after LPE therapy, the PB Th1, Th2, Th17and Treg cells frequency variation were conducted respectively by correlation analysis compared with clinical scoring. Results showed that the decline of frequency in Thl and Th17cells was positively correlated with the improvement of clinical score (respectively r=0.613, r=-0.521, P<0.05); The increase of frequency in Treg cells was positively correlated with the improvement of clinical score (r=0.584, P<0.05); However, the increase of frequency in Th2cells had no correlation with the improvement of clinical score (r=0.472, P>0.05).(8)Before LPE therapy, the PB Th1, Th2,Th17and Treg cells frequency were conducted respectively by correlation analysis compared with AChR-Ab level. Results showed that there was no correlation among them(respectively r=0.457, r=-0.335, r=0.274, P>0.05); Treg cells frequency was negatively correlated to AChR-Ab level (r=-0.381, P<0.05).(9)3days after LPE therapy, the PB Th1, Th2, Th17and Treg cells frequency variation were conducted respectively by correlation analysis compared with AChR-Ab level. Results showed that there was no correlation among them(respectively r=0.524, r=0.372, r=0.483, r=0.429, P>0.05)Conclusions:LPE therapy has a therapeutic effect to MG through correcting for the ratio imbalance of both Th1/Th2and Th17/Treg in MG patients.