Comparing the Autoantibody Levels and Clinical Efficacy of Double Filtration Plasmapheresis, Immunoadsorption, and Intravenous Immunoglobulin for the Treatment of Late-onset Myasthenia Gravis
Comparing the Autoantibody Levels and Clinical Efficacy of Double Filtration Plasmapheresis, Immunoadsorption, and Intravenous Immunoglobulin for the Treatment of Late-onset Myasthenia Gravis
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双重过滤血浆置换、免疫吸附和静脉注射免疫球蛋白治疗迟发性重症肌无力的自身抗体水平和临床疗效比较
DOI：
10.1111/j.1744-9987.2009.00751.x
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发表时间：
2010-04-01
影响因子：
1.9
通讯作者：
Gu, Yong
中科院分区：
文献类型：
--
作者：
Liu, Jun-Feng;Wang, Wei-Xin;Gu, Yong
本研究旨在探讨双滤过血浆置换（DFPP）、免疫吸附（IA）和静脉注射免疫球蛋白（IVIg）治疗晚发性重症肌无力（MG）的疗效。40例迟发性MG患者随机分为3组：15例采用DFPP治疗；10例患者接受IA治疗；15例患者接受IVIg治疗。治疗前后检测titin抗体（titin -ab）、乙酰胆碱受体抗体（AChR-ab）、突触前膜抗体（Prsm-ab）滴度，采用盲法检测治疗前后定量MG评分（QMG评分）。分析两组患者的临床疗效、呼吸支持时间、住院时间以及三种抗体与QMG评分的相关性。与前处理相比，Titin-ab、AChR-ab、PrsmR-ab值均显著降低（P < 0.05）；与IVIg组相比，dppp组和IA组Titin-ab值明显降低（P < 0.01）；DFPP组与IA组间差异无统计学意义（P < 0.05）。虽然三组患者QMG评分均有显著提高，但DFPP组和IA组QMG评分下降幅度均明显高于IVIg组（P < 0.01）。两种治疗均能有效改善患儿的症状，但DFPP组和IA组的临床疗效高于IVIg组（P < 0.05），缓解时间（P < 0.01）、住院时间（P < 0.05）和呼吸支持次数（P < 0.05）均高于IVIg组（P < 0.05）。经Pearson相关分析，Titin-ab的降低与QMG评分的降低呈纵向相关（r = 0.6107, P < 0.01）。DFPP和IA短期临床效果均优于输注免疫球蛋白，可快速有效清除迟发性MG患者的致病抗体，尤其是Titin-ab。
The aim of this study was to investigate the effects of double-filtration plasmapheresis (DFPP), immunoadsorption (IA) and intravenous immunoglobulin (IVIg) in the treatment of late-onset myasthenia gravis (MG). A total of 40 late-onset MG patients were randomly divided into three groups: 15 patients were treated with DFPP; 10 patients were treated with IA; and 15 patients received IVIg. The titers of titin antibodies (Titin-ab), acetylcholine receptor antibodies (AChR-ab), presynaptic membrane antibody (Prsm-ab) were detected before and after the treatment, and the quantitative MG score (QMG score) was assessed by blinded examiners before and immediately after the entire course of treatment. The clinical efficacy, duration of respiratory support, hospital stay, and the correlation between the three antibodies and the QMG score were also analyzed. Compared to pretreatment, the values of Titin-ab, AChR-ab, and PrsmR-ab were all dramatically decreased (P < 0.05); meanwhile the value of Titin-ab in the DFPP and IA groups decreased much more than in the IVIg group (P < 0.01); however, no statistical difference was found between the DFPP and IA groups (P > 0.05). Although the QMG score significantly improved in all three groups, it decreased much more in both the DFPP and IA groups than that in the IVIg group (P < 0.01). Symptoms were also effectively ameliorated by all treatments, but the clinical efficacy of the DFPP and IA groups was higher than the IVIg group (P < 0.05), as was the remission time (P < 0.01), the duration of hospital stay (P < 0.05), and the number of respiratory supports required (P < 0.05). Using Pearson's correlation, the decrease of Titin-ab showed a longitudinal correlation with the decrease of QMG score (r = 0.6107, P < 0.01). Both DFPP and IA showed better short-term clinical effectiveness than immunoglobulin transfusion, rapidly and effectively clearing the pathogenic antibodies in late-onset MG patients, especially for Titin-ab.