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目的 了解重症肌无力 (MG)患者对糖皮质激素 (GC)敏感性与糖皮质激素受体 (GR)的关系。方法 观察 10例MG患者及 10名健康对照。采用 3H 地塞米松 ( 3H DEX)放射配体法测定外周血单个核细胞 (PBMC)GR。分别用植物血凝素 (PHA)、髓鞘碱性蛋白 (MBP)、乙酰胆碱受体 (AChR)刺激PBMC ,3H TdR掺入法检测体外淋巴细胞增殖反应 ,地塞米松 (DEX)抑制淋巴细胞增殖反应。结果 正常对照及MG患者PBMC对PHA及MBP刺激的增殖反应差别不显著 (P >0 0 5)。而MG患者PBMC对AChR的反应明显高于正常对照者 (P <0 0 1)。DEX对MG患者PBMC特异性增殖反应的抑制率为 4 2 14% ,而对正常对照PBMC的增殖反应的抑制率为 2 1 62 % ,两组间有很显著区别 (P <0 0 1)。GR数与DEX抑制率间有很良好的相关关系 (r =0 94 3,P <0 0 1)。结论 MGPBMCGR数与体外DEX对PBMC特异性增殖反应的抑制效应有良好的一致性。DEX对抗原特异性淋巴细胞增殖反应的抑制性可作为了解MG患者对GC敏感性的一项指标。
Objective To investigate the relationship between glucocorticoid (GC) sensitivity and glucocorticoid receptor (GR) in patients with myasthenia gravis (MG). Methods Ten patients with MG and 10 healthy controls were observed. Peripheral blood mononuclear cells (PBMC) GR were measured by 3H dexamethasone (3H DEX) radioligand assay. PBMCs were stimulated with phytohemagglutinin (PHA), myelin basic protein (MBP) and acetylcholine receptor (AChR) respectively, and lymphocyte proliferation reaction was detected by 3H TdR incorporation. Dexamethasone (DEX) inhibited lymphocyte proliferation reaction. Results There was no significant difference in the proliferative responses between PBMCs stimulated by PHA and MBP in normal controls and MG patients (P> 0.05). However, the response of PBMCs to AChR in MG patients was significantly higher than that of normal controls (P <0.01). The inhibitory rate of DEX on PBMC-specific proliferative response in MG patients was 4214%, while that on normal control PBMCs was 2162%. There was a significant difference between the two groups (P <0.01). There was a good correlation between GR number and DEX inhibition rate (r = 0 94 3, P <0.01). Conclusions The inhibitory effect of MGPBMCGR number on PBMC-specific proliferative responses in vitro is in good agreement. The inhibitory effect of DEX on antigen-specific lymphoproliferative responses can be used as an indicator of GC sensitivity in patients with MG.