並列タイトル等血清反応陰性患者における免疫介在性重症筋無力症診断のための運動終板の解析
授与機関名Nagasaki University (長崎大学)
一般注記This study aimed to evaluate the diagnostic usefulness of motor end-plate (MEP) analysis along with clustered acetylcholine receptor (AChR) antibody (Ab) assays in patients with myasthenia-like symptoms but negative routine AChR and muscle-specific kinase (MuSK) Ab tests. MEP analysis of muscle biopsies of the biceps brachii was performed in 20 patients to try to differentiate between those with or without immune-mediated myasthenia gravis (MG). Using a quantitative method, complement C3 deposition and AChR densities in MEPs were examined. Independently, cell-based assays were used to detect serum clustered-AChR Abs. Only five of 20 patients had complement deposition at MEPs; four of these patients had reduced AChR densities similar to those in patients with typical AChR Ab positive MG, and distinct from those in the remaining 15 patients. Two of the four serum samples from these patients had clustered-AChR Abs. All complement-positive patients were considered as having immune-mediated MG and improved with appropriate treatments; although one patient presented with MG 3 years later, the remaining patients had other diagnoses during over 10 years of follow-up. These results suggest the usefulness of MEP analysis of muscle biopsies in diagnosing immune-mediated MG in seronegative patients with myasthenia-like symptoms but, due to the invasiveness of the muscle biopsy procedure, clustered AChR Abs should, if possible, be tested first.
長崎大学学位論文 学位記番号:博(医歯薬)甲第1499号 学位授与年月日:令和5年3月1日
Author: Atsushi Nagaoka, Akira Tsujino, Hirokazu Shiraishi, Tadashi Kanamoto, Tomoaki Shima, Shunsuke Yoshimura, Teiichiro Miyazaki, Yohei Tateishi, Mitsuhiro Tsujihata, Masakatsu Motomura, Susan Maxwell, Osamu Higuchi, David Beeson, Angela Vincent
Citation: Journal of the Neurological Sciences, 443, art. no. 120494; 2022
identifier:Nagasaki University (長崎大学), 博士(医学) (2023-03-01)
http://hdl.handle.net/10069/00042232
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