Analysis Of Prednisone Treatment Insensitive Factors In Patients With Myasthenia Gravis

Myasthenia gravis?MG?is an autoimmune disease that affects the postsynaptic membrane and is characterized by the weakness of the morbid fatigue muscle.The pathogenesis is that the related antibody acts on the postsynaptic membrane and causes the choline transmission to be damaged.There are glucocorticoid,thymectomy,immunosuppressive agents,plasma exchange and so on.Glucocorticoid is a gleam of clinical medicine for the treatment of MG,through a combination of glucocorticoid receptors?glucocorticoid receptors,GR?,suppress autoimmune reaction,reduce the generation of AChR antibody and prompted the motor end plate repair and regeneration,improve the transmission of the nerve-muscle joint function.Noel-suberville C et al^[1]found that the GR level of the rats decreased after the high cholesterol diet.Therefore,the increase of blood lipids may result in the decrease of GR level,and then the effect of prednisone treatment is poor.There are many prednisone treatment insensitive factors in patients with myasthenia gravis.This study based on 60 patients with myasthenia gravis treated in our hospital including gender,age,c-reactive protein,blood glucose,abnormal thyroid function,elevated blood lipids,thymus,AChR-Ab and so on.In order to provide more evidence for the selection of clinical medicine and guide the clinical treatment of MG.Objective:In this study,many prednisone treatment insensitive factors in patients with myasthenia gravis were discussed,to provide more evidence for the clinical treatment of myasthenia gravis,and guide the rational use of drugs.Methods:Retrospective analysis of 60 cases of generalized MG patients diagnosed and treated by prednisone in the department of neurology of the first hospital of Shanxi medical university from June 2014 to December 2017.According to the quantitative myasthenia gravis?QMG score?,patients are divided into prednisone treatment sensitive group and insensitive group,and we compare gender,age,CRP,thyroid function,blood glucose,blood lipids,thymus,AChR-Ab in two groups,then analyze insensitive factors.Results:1.Prednisone treatment sensitive group and insensitive group gender differences have no statistical significance between MG patients??²=0.267,P=0.606?.2.Prednisone treatment between the sensitive group and insensitive group there was no statistically significant age difference??²=3.267,P=0.071?.3.There was no statistical difference in CRP level between prednisone sensitive group and insensitive group??²=3.267,P=0.071?.4.The blood glucose of the patients in the sensitive group was 7.10±1.33mmol/L,and the blood glucose was 6.87±1.10mmol/L in the non-sensitive group,and the blood glucose between the two groups was not statistically significant?P=0.462?.5.There was a statistically significant difference between prednisone sensitive and insensitive groups??²=5.400,P=0.020?,and the rate of abnormal thyroid function in prednisone treatment insensitive group was higher than that in sensitive group.Hyperthyroidism between prednisone treatment sensitive group and insensitive group was statistically significant??²=13.067,P=0.000?.The risk of hyperthyroidism in the insensitive group was higher than that in the sensitive group.There was no significant difference in prednisone in the treatment of hypothyroidism between the sensitive group and the insensitive group??²=3.267,P=0.071?.6.There was a statistically significant difference between prednisone sensitive and insensitive groups??²=6.667,P=0.010?,and the rate of elevated blood lipids in prednisone treatment insensitive group was higher than that in sensitive group.The increase of cholesterol between prednisone treatment sensitive group and insensitive group was statistically significant??²=4.267,P=0.039?.The increase of cholesterol in the insensitive group was higher than that in the sensitive group.There was no significant difference in the triglyceride level between the sensitive group and the insensitive group??²=3.267,P=0.071?.There was no significant difference in LDL-C between the sensitive group and the insensitive group in prednisone treatment??²=3.267,P=0.071?.7.There was a statistically significant difference between prednisone sensitive and insensitive groups??²=4.267,P=0.039?,and the rate of abnormal thymus in prednisone treatment insensitive group was higher than that in sensitive group.The thymus hyperplasia between prednisone treatment sensitive group and insensitive group was statistically significant??²=9.600,P=0.002?.The probability of thymus hyperplasia in the insensitive group was higher than that of the sensitive group.The thymoma between prednisone treatment sensitive group and insensitive group was statistically significant??²=6.667,P=0.010?,and the rate of thymoma in insensitive group was higher than that in sensitive group.8.There were statistically significant differences in the AChR-Ab positive ratio between prednisone treatment insensitive group and the sensitive group??²=4.267,P=0.039?,and the incidence of AChR-Ab positive in prednisone treatment sensitive group was higher than that in the insensitive group.The concentration of AChR-Ab in prednisone treatment sensitive group was 2.91±1.98,and the AChR-Ab concentration of the insensitive group was 5.22±5.36.The AChR-Ab concentration of the two groups was statistically different?P=0.033?,and the AChR-Ab concentration in the insensitive group was higher than that in the sensitive group.9.Logistic regression model analysis showed that the abnormal thyroid function?OR=0.160?,elevated blood lipids?OR=0.198?,abnormal thymus?OR=0.206?,and AChR-Ab?OR=4.911?were the influential factors affecting the efficacy of prednisone in the treatment of MG patients.In the case that other variables remain unchanged,the likelihood of insensitivity to prednisone of patients with normal thyroid function is 0.16times that of those with abnormal thyroid function,95%confidence interval is?0.035,0.723?.In the case that other variables remained unchanged,the possibility of prednisone treatment insensitive of patients with normal blood lipids is 0.198 times of the elevated blood lipids and 95%confidence interval is?0.048,0.811?.In the case that other variables remained unchanged,the likelihood of insensitivity to prednisone of patients with normal thymus is 0.206 times that of those with abnormal thymus,95%confidence interval is?0.045,0.931?.In the case that other variables remained unchanged,the likelihood of insensitivity to prednisone of patients with AChR-Ab negative is 4.911times that of those with AChR-Ab positive,95%confidence interval is?1.151,20.953?.Conclusion:1.The gender,age,CRP and blood glucose of generalized MG patients did not affect the prednisone treatment effect.2.The treatment effect of prednisone was poor in generalized MG patients with abnormal thyroid function.3.Prednisone has poor efficacy in generalized MG patients with elevated blood lipids.4.Prednisone has poor efficacy in generalized MG patients with abnormal thymic glands.5.In patients with AChR-Ab positive generalized MG,prednisone was effective,and the AChR-Ab titer of prednisone insensitive group was higher than that of sensitive group.