Mild clinical expression of myasthenia gravis associated with autoimmune thyroid diseases.
Mild clinical expression of myasthenia gravis associated with autoimmune thyroid diseases.
复制标题
DOI：
10.1210/jcem.82.2.3749
复制
发表时间：
1997-02
期刊：
影响因子：
44.1
通讯作者：
中科院分区：
文献类型：
--
作者：
重症肌无力（MG）可能与自身免疫性甲状腺疾病（AITD）有关。本研究的目的是比较合并AITD的MG与不合并AITD的MG的特征。共有129例MG患者（男性34例，女性95例，年龄11-81岁）被细分为：A组56例合并AITD的MG患者[25例合并自身免疫性甲状腺炎，31例合并Graves病（GD）]；B组非自身免疫性甲状腺疾病MG患者21例；C组52例MG患者，无甲状腺疾病。根据Osserman评分对MG的严重程度进行排序。实验室评价包括抗甲状腺和抗乙酰胆碱受体（AchRAb）抗体检测。眼部MG （Osserman’s 1级）发生率A组（41.0%）高于B组（14.2%,P or = 2B）， B组（57.1%,P < 0.03）和C组（51.9%,P < 0.02）高于A组（28.5%）。有眼病临床证据的GD患者眼部MG发生率（57.8%）高于无眼病临床证据的GD患者（16.6%）（P = 0.05）。A组胸腺疾病发生率（26.7%）低于B组（71.4%,P = 0.001）或C组（59.7%,P = 0.001）。A、B、C组胸腺增生的患病率分别为17.8%、38.0%、40.3%；胸腺瘤的患病率分别为8.9%、33.4%和19.4%。当仅考虑广泛性MG患者时，A组胸腺疾病发生率（40.6%）低于其他组（69.4%）（P < 0.02）。B组和C组AchRAb发生率分别为57.1%和57.6% （P < 0.03）高于A组（35.7%）。综上所述，MG合并AITD临床表现较轻，优先累及眼部，胸腺疾病和AchRAb发生率较低。这支持了眼部和广泛性MG是具有不同相关疾病谱的独立疾病的假设。非自身免疫性甲状腺疾病对MG的特征无影响。眼部MG和AITD的关联可能是由于共同的自身免疫机制和/或特殊的遗传背景。
Myasthenia gravis (MG) may occur in association with autoimmune thyroid diseases (AITD). The aim of this study was to evaluate the features of MG associated with AITD compared to those of MG without AITD. A total of 129 MG patients (34 men and 95 women; age range, 11-81 yr) were subdivided into: group A, 56 MG patients with AITD [25 with autoimmune thyroiditis and 31 with Graves' disease (GD)]; group B, 21 MG patients with nonautoimmune thyroid diseases; and group C, 52 MG patients without thyroid disease. The severity of MG was ranked according to the Osserman score. Laboratory evaluation included assays for antithyroid and antiacetylcholine receptor (AchRAb) antibodies. Ocular MG (Osserman's class 1) was more frequent in group A (41.0%) than in group B (14.2%; P or = 2B) was more frequent in groups B (57.1%; P < 0.03) and C (51.9%; P < 0.02) than in group A (28.5%). GD patients with clinical evidence of ophthalmopathy had a higher frequency (P = 0.05) of ocular MG (57.8%) than GD patients without clinical ophthalmopathy (16.6%). Thymic disease was less frequent in group A (26.7%) than in group B (71.4%; P = 0.001) or C (59.7%; P = 0.001). The prevalence of thymic hyperplasia was 17.8%, 38.0%, and 40.3% in groups A, B, and C, respectively; the prevalence of thymoma was 8.9%, 33.4%, and 19.4%. When only patients with generalized MG were considered, thymic disease was less frequent (P < 0.02) in group A (40.6%) than in the remaining groups (69.4%). AchRAb was more frequent in groups B (57.1%) and C (57.6%; P < 0.03) than in group A (35.7%). In conclusion, MG associated with AITD has a mild clinical expression, with preferential ocular involvement and lower frequency of thymic disease and AchRAb. This supports the hypothesis that ocular and generalized MG are separate diseases with different spectra of associated diseases. Nonautoimmune thyroid diseases have no influence on the features of MG. The association of ocular MG and AITD might be due to a common autoimmune mechanism and/or a peculiar genetic background.