| Object ive1. To study serological characteristic of ocular myasthenia gravis(OMG).2. To summarise clinical characteristic in diagonosis and therapy of ocular myasthenia gravis(OMG).3. To assesse the value of laboratory test data of OMG in predicting the progression to generalised myasthenia gravis(GMG).Methods1. Clinical material including clinical manifestation,auxiliary examination,therapy and course developing were retrospecively analysed to the113OMG patients.2. Cell based assay(CBA) was applied to detect adult and foetal acetylcholine (AChR) antibody and muscle specific receptor tyrosine kinase(MuSK) antibody.3. The clinical data of groups divided by AChR antibody were comparatively analysed by SPSS17.0. Adult and foetal AChR antibodies were comparatively studied. The correlation between level of AChR antibody and other clinical data was analysed.Results1. Adult-onset OMG was liable to be onset in males over age40, The most common initial presenting was ptosis(84.07%), and the minority started with diplopia(15.93%). And nearly all the OMG patients (97.8%) developed with ptosis,54.4%with various eye movement disorder.2. The positive ratios of fatigue test and neostigmine test were79.44%and84.85%respectively. Abnormal rate of repetitive nerve stimulation was45.35%, and the positive ratios of orbicularis oculi and deltoid were both higher than abductor pollicis brevis with statistical significance(P<0.05). Abnormal rate of thyroid antibodies was28%.16.67%had hymic hyperplasia and11.76%had thymoma.3. The positive rate of AChR antibody was73.45%by CBA. Antibody to adult and foetal AChR were proved in63.96%and62.83%sera respectively, and all the sera were MuSK antibody ngative.4. Distribution of patients with antibody to adult or foetal AChR was not identical.14.46%of patiehts with AChR antibody was only with antibody to adult AChR; And13.25%was only with antibody to foetal AChR. The result of AChR antibody were consistent for77.88%(88/113)OMG patients.5. QMG score of group with antibody only to adult AChR was higher than group with antibody only to foetal AChR(P<0.05). Rate of progression to GMG in group with antibody to both adult and foetal AchR was significantly higher than group with no AchR antibody (P<0.05).6.86.11%of patients receiving prednisone for treatment were relieved or improved. Followed up for2-28months,12.39%OMG patients progressed to GMG.Conclusion1. Adult-onset OMG often onset in middle-aged males.The commonest manifestation of OMG includes ptosis, diplopia, and it is often accompanied with abnormality of thymus and thyroid.2. In OMG, the positive ratio of neostigmine test is high, And RNS is objective, in which the abnormal rate of orbicularis oculi and deltoid are both higher than abductor pollicis brevis. OMG patients with skeletal muscles of limb abnormal in RNS may develop to GMG.3. The positive rate of AChR antibody was73.45%by CBA. And the difference between positive ratios of antibody to adult AChR and that of antibody to foetal AChR is not significant. And MuSK antibody is uncommon in OMG Patients.4. Distribution of patients with antibody to adult or foetal AChR was not identical, which may indicate that there are antibodies only to the ε or γ subunit of AChR in sera of some OMG patients.5. Patients only with antibody to adult AChR are with higher disease severity. OMG patients with antibody to both adult and foetal AChR are more at risk for progressing to GMG.6. Patients with only apertor oculi involved can be with antibody only to foetal AChR; And patients with only oculomotor muscle involved can be with antibody only to adult AChR, witch may indicate other antibody exsits in OMG patients.7. OMG patients are sensitive to prednisone for treatment. |
PDF Full Text Request