目的 探讨Fas介导的细胞凋亡与重症肌无力(MG)合并甲状腺功能亢进(甲亢)机制的关系.方法 对2007年10月至2009年12月中山大学附属第五医院收治的17例MG患者及13名健康对照者进行研究,采用流式细胞技术检测外周血T淋巴细胞表面CD4、CD8及Fas的表达.结果 合并甲亢的MG患者(5例)中眼肌型MG比例高于无合并甲亢MG组(40.0％对16.7％),胸腺增生及胸腺瘤的发生率均比无合并甲亢MG组低(前者20％对50％；后者0对25％),但差异无统计学意义.合并甲亢MG组患者外周血T淋巴细胞中CD4+ CD8-细胞比例比对照组高(P =0.034).合并甲亢MG组外周血T淋巴细胞中CD4+Fas+、CD4+ CD8+ Fas+细胞比例比对照组高,CD4+ CD8+ Fas+细胞比例比无合并甲亢MG组高,差异有统计学意义(均P＜0.05).结论 甲亢在MG中发生率较高；合并甲亢的MG患者外周血CD4+T淋巴细胞中Fas的表达升高,可能与MG合并甲亢的发病机制有关.%Objective To investigate the correlation between Fas-mediated apoptosis and the pathogenesis of myasthenia gravis (MG) complicating with hyperthyoidisra. Methods A total of 17 patients with MG and 13 normal controls were enrolled from The Fifth Affiliated Hospital of Sun Yat-sen University between October 2007 and December 2009. Expressions of cellular surface CD4, CD8 and Fas in peripheral blood T lymphocyte were analyzed via flow cytometry. Results Of 5 patients with MG who had hyperthyroidism,prevalence of ocular MG was higher than those who had MG without hyperthyroidism (40.0% vs 16.7% ) , and by contrast, lower prevalence of thyroid hyperplasia and thymoma was associated with patients who had MG without hyperthyroidism (thyroid hyperplasia:20% vs 50% ;thymoma:0 vs 25% .both P >0.05). Patients with MG complicating with hyperthyroidism yielded a higher proportion of peripheral blood CD4 + CD8" cells as compared with normal controls (P =0.034). Additionally,as compared with that o￡ controls,a higher proportion of peripheral blood CD4 + Fas + and CD4 + CD8 + Fas + cells was found in patients who had MG complicating with hyperthyroidism (both P < 0.05). These patients were found to present higher proportion of peripheral CD4 + CD8 + Fas + than those who had MG without hyperthyroidism (P < 0.05). Conclusion Higher prevalence of hyperthyroidism is associated in patients with MG. Up-regulated expression of Fas antigen in peripheral blood CD4 + T lymphocytes in patients who had MG complicating with hyperthyroidism may be correlated with the pathogenesis.
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