Імунологічні підтипи міастенії серед дорослих хворих в Україні

Abstract

Метою даної роботи стало вивчення імунологічного підтипу у хворих на міастенію. Об’єктом дослідження був імунологічний підтип у хворих на міастенію шляхом виявлення антитіл до рецепторів ацетилхоліну та/або антитіл до м’язово-специфічної тирозин-кінази у плазмі методом імунофер-ментного аналізу. Було проведено визначення антитіл до рецепторів ацетилхоліну та м’язово-специфічної тирозин-кінази у 96 хворих на міастенію (71 – з генералізованою, 25 – з очною формою). Антитіла до рецепторів ацетилхоліну було виявлено у 57 (80,3%) з 71 хворих з генералізованою та у 13 (52,0%) з 25-ти хворих з очною формою міастенії. У 6 (8,5%) пацієнтів з генералізованою міастенією були виявлені антитіла до м'язово-специфічної тирозин-кінази. При очній формі ці антитіла виявлено не було. У 8 (11,3%) хворих з генералізованою міастенією та у 12 (48,0%) хворих на очну форму міастенії антитіл виявлено не було.; Объектом исследования стал иммунологический подтип у больных миастенией путем выявления антител к рецепторам ацетилхолина и / или антител к мышечно-специфической тирозин-киназе в плазме методом иммуноферментного анализа. Было проведено определение антител к рецепторам ацетилхолина и мышечно-специфической тирозин-киназе у 96 больных миастенией (71 - с генерали-зованной, 25 - с глазной формой). Антитела к рецепторам ацетилхолина были выявлены у 57 (80,3%)из 71 больных с генерализованной и у 13 (52,0%) из 25-ти больных с глазной формой миастении. У 6 (8,5%) пациентов с генерализованной миастенией были обнаружены антитела к мышечно-специфической тирозин-киназе. При глазной форме эти антитела обнаружены не были. У 8 (11,3%) больных с генерализованной и у 12 (48,0%)больных с глазной формой миастении антител обнаружено не было.; The approaches to the diagnosis of myasthenia gravis that have been proposed before include a clinical examination, a proserin test, and electroneuromyography. At the same time, data on specific immunological tests as ones of the most relevant in the diagnosis and prognosis of the myasthenia gravis course are not commonly accepted in Ukraine. According to foreign literature, antibodies to acetylcholine receptors are detected in about 80-85% of patients with generalized form and in about 50% of patients with ocular form of myasthenia gravis. Among the "seronegative" patients, antibodies to muscle-specific tyrosine kinase can be detected in some patients. In Ukraine, the frequency of antibodies to acetylcholine receptors and muscle-specific tyrosine-kinase is not well studied and requires further in-depth investigation. The aim of this work wasto study the immunological subtypes in adult patients with myasthenia gravis. Methods. Antibodies toacetylcholine receptors and/or antibodies to muscle-specific tyrosine-kinase in plasma in patients with myas-thenia gravis were detected with ELISA tests. Results. 96 patients (56 women and 40 men) with myasthenia gravis were involved into the study during 2014 – 2016. 71 patients were diagnosed to have generalized and 25 were diagnosed to have ocular form of myasthenia gravis. The average age of patients was 50.5 ± 12.4 years; the mean duration of the disease was 4.4 ± 1.2 years. When analyzing the duration of the disease, 2 peaks of disease onset were detected: early onset (the first manifestations of the disease before the age of 40) was registered in 49 patients, and the late onset (the first manifestations of the disease at the age of over 60 years) was registered in 47 patients. In the group of patients with early onset, women dominated (37 women over 12 men), while in the late-onset group, men dominated(40 men over 12 women respectively). Antibodies to acetylcholine receptors were detected in 57 (80.3%) out of 71 patients with generalized form and in 13 (52%) out of 25 patients with ocular form of myasthenia gravis. According to our study, 6 (8.5%) patients with generalized myasthenia gravis were found out to have antibodies to muscle-specific tyrosine-kinase. In the case of an ocular form, these antibodies were not detected at all. In 8 (11.3%) patients with a generalized form of myasthenia and in 12 (48%) patients with ocular form of myasthenia antibodies were not detected. These patients can be attributed to the seronegative type of myasthenia. Conclusions. The main immunological subtype of myasthenia gravis, regardless of age, is myasthenia associatedwith antibodies to acetylcholine receptors and is observed in 80.3% of patients. Myasthenia associated with antibodies to mus-cle-specific tyrosine-kinase is relatively uncommon (8.5% of patients with myasthenia) and also does not de-pend on the age of disease onset. Patients with an ocular form of myasthenia gravis were revealed to have exclusively antibodies to muscle-specific tyrosine-kinase. In 21% of patients, antibodies were not detected ei-ther to acetylcholine receptors or to muscle-specific tyrosine kinase.