CLINICAl AND IMMUNOPATHOLOGICAL.OGICAI. STUDY ON THE THYMUS IN MYASTHENIA GRAVIS
Objective Directing towards the thymus and emphasizing mainly on the clinical and immunopathofogical study to probe its actior of the diagnosis,treatmeant and pathogcnesis cfmyasthema gravis(MG). Results tnd Dicusslons I .Diagnosis of MG with thymus pathologic lesions: I.MG with thymus hyetplasta It was shown by midstemum. CT scanning Germinal center arises from B ceil was determined by immunohistologic stain(Tol 5 marked); 2MG with thymoma It usualy occures at midaged man and apt to relapses on myasthenic crises. Positive rate of serum CAE-Ab(anti-citric acid extract antibody of human skeletal musie) was used tc find small thymoma early Rabbit Anti-serum against human CAE was labeled to determine thymoma AgNOR(argyrophilic stain of nuclear organizer region)was used to differentiate bemgn and maligant thymoma .As Muller-Hermlink” s classfication.thymoma of cortical type occurred more common and reliable to infiltration Ⅱ Treatment of MG with thymus pathoiogic lestons Except for symptomatic treatment with anti-acytlecholine drugs.MPSS or CTX intravenous perfusion had effect to relieve the myasthenic cnsis Using thymus radiation therapy to 134 cases, the complete remission and remarkable improvement rates were 66.5%.Rhe long-term effect followed up was rather stable. Using percutanous paracentesis into thymus gland for intervention treatment to 13 cases, all of them showed effect within one week.10 cases followed up more than 3 years,9 cases were complete remission or remarkable improvement Thymectmy is still a basic therapy for MG.In 102 cases with thymectomy,the complete remission and remarkable improvement rates were 59.8%,mortanty was 176%.Continual observation of CAE-Ab could contribute to determine the pateint” s prognosis,9 patients in severe condition followed up within 3 years,their serum CAE-Ab antibody titers persisted at high lever,3 Of them died,but 7 patients followed up within I year,those of their serum antibodies decreased quickly,5 cases of them got complle remission. Asides the question whether being thymectomied or not operate.it seems that treatment should direct towards the thymus,had better to take corresponding treatment early,indivually and from time to time and use each trcatment correctly under strict monitor to make effort for heigh effcct;It also needs futher following up and creating new therapy for to raise long-term effect Ⅲ .Thymus for the pathogenises of MG: 1.Thymus and skeletal muscie both exist nAchR common antigen; 2.T-cells play the crucial role in MG autoimmune response,they form the complex of TCR-nAchR MHC ,and become the basis of immune resconsibillity in MG; 3.Thymus epithelium cells and thymocytes make interaction abnormally to response again, st foreign antigen(as virus infection);and result in autoimmune response for self-antigen owing to lose immunotolerance. 4 Thymoma epithelium cells exist different inheritance susceptibilities,the alamine at position 57(Ala 57) of HLA - DO β gene expressing is more signiticant association with Chinese MG patients with thymoma.
complete remission、radiation therapy、virus infection
8
R5 ;R9
2005-07-07（万方平台首次上网日期，不代表论文的发表时间）
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