To Explore The Influence Of Blood Serum’s Low Density Iipoprotein-receptor 4(LRP4),B Cell Activating Factor-receptor(BAFF-R) In Patients Of Spleen And Stomach Deficiency Of Myasthenia Gravis During Treatment

Objective1. To evaluate LRP4 and BAFF-R in serum of patients with spleen and stomach deficiency in myasthenia gravis and healthy group, observing the differences between the two groups.2.To analyze the effect of treatment strengthening the spleen and repl-enishing qi with common immunization therapy on LRP4 and BAFF-R level of the spleen and stomach deficiency in myasthenia gravis, and its possible effect mechanism.MethodsTo select 34 cases of the spleen and stomach deficiency group and 26 cases of healthy control group, from Oct.2014 to Feb.2015 in the First Affiliated Hospital of TCM, and detect the LRP4 and BAFF-R levels in blood serum by ELISA method, and carry on the statistical analysis, to separate them into different groups, using different treatments (pyridostigmine+Chinese Herb, pyridostigm ine+ prednisone+Chinese Herb, pyridostigmine+prednisone+cytotoxic drugs+Chi nese Herb, cytotoxic drugs include azathioprine, ciclosporin, tacrolimus)and determine LRP4, BAFF-R level before and after treatment using T test or rank-sum test to analysis.ResultsIn the use of traditional Chinese medicine, using strengthening the spleen and replenishing qi, sun lift depression as a rule, with Buzhong Yiqi Decoction, tonic medicine accounted for the largest proportion(48%), followed by rheumatism medicine (20%), diuretics for eliminating dampness and Qi regulating drugs in third (10%).Before the treatment, compared with healthy groups, the serum of LRP4 in patients with spleen and stomach deficiency of myasthenia gravis is lower (the ratio between the two is 0.79),and the serum of BAFF-R is higher(the ratio between the two is 1.689).After using different treatments,the symptoms have improved, and the QMG score has statistical significance (P<0.05),LRP4 concentration has elevated (the ratio between the two is 0.894) and BAFF-R concentration has decreased (the ratio between the two is 1.159).Compared with different groups,LRP4 has statistically significant in patients with muscular atrophy(P<0.05), and BAFF-R has statistically significant in patients with acute severe type(P <0.05).Among them, the use of corticosteroids and combined with cytotoxic drugs during the treatment, LRP4 and BAFF-R values have statistically significant.The patients with acute severe type, there was a negatice correlation between LRP4 and QMG(r=-0.684, P=0.000), and there was a positive correlation between BAFF-R and QMG (r=0.846, P=0.000).ConclusionCompared with the healthy group,the concentration of LRP4 and BAFF-R in patients with spleen and stomach dificency of myasthenia gravis are differ ent, which refers that it has some relationship on the disease progression, LRP4 can reflect the length of disease course, BAFF-R and LRP4 can be to some ex tent, reflct the severity of the disease.Afer different treatments,the con-centration of LRP4 is increased, the concentration of BAFF-R is decreased, Especially in the use of glucocorticoid and cytotoxic drugs (azathioprine, tacrolimus and ciclosporin) were statistically signif-icant value, suggest-ing that it may be through inhibition of T cascade reaction, B cells, blocking the autoimmune reaction, thereby reducing the number of LRP4 self consumption or invalid combination, so as to relieve the symptoms of myasthenia gravis; whether the traditional Chinese medicine invigorating the spleen and replen-ishing qi can change LRP4 and BAFF-R concentration during the treatment alone, it needs further study.