首页|重症肌无力患者血清致病性自身抗体的认识进展和诊断技术评述

重症肌无力患者血清致病性自身抗体的认识进展和诊断技术评述

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重症肌无力(MG)是一种由自身抗体介导的累及神经肌肉接头的自身免疫性疾病,致病性自身抗体的检测对其诊断以及病情判断至关重要。商业检测机构和医院常用放射免疫沉淀法、酶联免疫吸附法或细胞免疫荧光法检测MG患者的血清抗体,但在敏感度和特异度方面存在不少问题,同时缺乏高级别循证医学的直接比较研究。近期SCREAM研究的发布用中国人的数据证实了细胞免疫荧光法的优势,为MG实验室诊断的优选推荐提供了Ⅰ级证据,填补了国内外空白。然而,上述检测方法所获得的结果均难以用于患者的纵向比较,并不能作为关联病情的最佳生物标志物。文中同时结合近些年对MG致病性自身抗体的认识进展尝试讨论这个问题,并对未来的发展进行展望。
Advancements in the understanding and diagnostic techniques of pathogenic autoantibodies in serum of patients with myasthenia gravis
Myasthenia gravis(MG)is an autoimmune disorder mediated by autoantibodies that target the neuromuscular junction.The detection of pathogenic autoantibodies is crucial for the diagnosis and assessment of the disease.Commercial testing institutions and hospitals commonly use techniques such as radioimmunoprecipitation,enzyme-linked immunosorbent assay,or cell-based assay to test the serum of MG patients.However,these methods have limitations in terms of sensitivity and specificity,and there is a lack of direct comparative studies using high-level evidence-based medicine.The recent release of the SCREAM study using data from Chinese individuals confirms the advantages of cell-based assay,providing level Ⅰ evidence for the preferred recommendation of MG laboratory diagnosis and filling the gap in both domestic and international fields.However,the results obtained from the aforementioned testing methods are difficult to use for longitudinal comparison of patients and may not serve as the best biomarkers for disease monitoring.This article attempts to discuss this question by combining recent advances in understanding the pathogenic autoantibodies of MG and provides an outlook on future developments.

Myasthenia gravisAutoantibodiesEvidence-based medicineDiagnosis

焦可馨、赵重波

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复旦大学附属华山医院神经内科国家神经疾病医学中心华山医院罕见病中心,上海 200040

重症肌无力 自身抗体 循证医学 诊断

国家重点研发计划上海市医企融合创新成果转化专项课题

2022YEC35013032022YEC3501303

2024

中华神经科杂志
中华医学会

中华神经科杂志

CSTPCD北大核心
影响因子:1.329
ISSN:1006-7876
年,卷(期):2024.57(1)
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