Myasthenia Graviste Jitter Parametrelerinin ve Asetilkolin Reseptör Antikor Titrelerinin Korelasyonu

Yıl 2020, , 450 - 455, 20.12.2020

Ahmet Candan Köylüoğlu , Halit Fidancı , İlker Öztürk

https://doi.org/10.37696/nkmj.759574

Öz

Amaç: Asetilkolin reseptör (AChR) antikor testi ve tek-lif elektromiyografi (TLEMG), myasthenia gravis (MG) tanısı için önemli olan iki testtir. Bu çalışmada AChR antikor titreleri ve stimülasyonlu TLEMG (STLEMG) arasında bir ilişki olup olmadığının bulunması amaçlanmıştır.
Materyal ve Metot: Klinik bulguları, ardışık sinir uyarımı (ASU) ve AChR antikor testi MG ile uyumlu olan hastalar bu retrospektif kohort çalışmasına dahil edildi. Hastaların yeni tanı almış olması gerekliydi. STLEMG hastalara uygulandı ve STLEMG parametreleri analiz edildi.
Bulgular: On altı hasta (11 erkek, 5 kadın) çalışmaya dahil edildi. Hastaların yaş ortalaması 54.1 ± 15.8 yıl idi. AChR antikor pozitifliği, ASU ve STLEMG parametrelerinde anormallik sırasıyla 13 (%81), 9 (%56) ve 14 (%88) hastada bulundu. Serum AChR antikor düzeyi ve artmış jitterli tek lif aksiyon potansiyel (TLAP) çiftlerinin yüzdesi arasında anlamlı pozitif bir korelasyon bulundu (p=0.019, r=0.639).
Sonuç: Bu çalışma AChR antikor titreleri ve artmış jitterli TLAP çiftlerinin yüzdesi arasında pozitif bir korelasyon olduğunu göstermiştir.

Anahtar Kelimeler

Asetilkolin reseptör antikoru, myasthenia gravis, stimülasyonlu tek-lif elektromiyografi

Correlation of Jitter Parameters and Acetylcholine Receptor Antibody Titers in Myasthenia Gravis

Öz

Aim: Acetylcholine receptor (AChR) antibody test and single-fiber electromyography (SFEMG) are two important tests for the diagnosis of myasthenia gravis (MG). In this study, it was aimed to find out whether there is a relationship between AChR antibody titers and stimulated SFEMG (SSFEMG) parameters.
Material and method: Patients whose clinical findings, repetitive nerve stimulation (RNS), and AChR antibody test were compatible with MG were included in this retrospective cohort study. The patients had to be newly diagnosed. SSFEMG was applied to the patients and SSFEMG parameters were analyzed.
Results: Sixteen patients (11 males, 5 females) were included in the study. The mean age of the patients was 54.1 ± 15.8 years. AChR antibody positivity, abnormality in RNS and SSFEMG parameters were found in 13 (81%), 9 (56%), 14 (88%) patients, respectively. A significant positive correlation was found between serum AChR antibody level and the percentage of apparent single fiber action potential (ASFAP) pairs with increased jitter (p=0.019, r=0.639).
Conclusion: This study showed a positive correlation between AChR antibody titers and the percentage of ASFAP pairs with increased jitter obtained by SSFEMG.

Anahtar Kelimeler

Acetylcholine receptor antibody, myasthenia gravis, stimulated single-fiber electromyography

Kaynakça

• Peeler CE, De Lott LB, Nagia L, Lemos J, Eggenberger ER, Cornblath WT. Clinical Utility of Acetylcholine Receptor Antibody Testing in Ocular Myasthenia Gravis. JAMA Neurol 2015; 72(10):1170-4.
• Trouth AJ, Dabi A, Solieman N, Kurukumbi M, Kalyanam J. Myasthenia Gravis: A Review. Autoimmune Dis 2012; 2012:874680.
• Howard Jr JF. Electrodiagnosis of Disorders of Neuromuscular Transmission. Phys Med Rehabil Clin N Am 2013; 24(1): 169-92.
• Oh SJ, Kim DE, Kuruoglu R, Bradley RJ, Dwyer D. Diagnostic Sensitivity of The Laboratory Tests in Myasthenia Gravis. Muscle and Nerve 1992; 15(6):720–4.
• Sanders DB, Howard Jr JF, Johns TR. Single-fiber electromyography in myasthenia gravis. Neurology 1979; 29(1): 68–76.
• Vincent A, Newsom-Davis J. Acetylcholine receptor antibody as a diagnostic test for myasthenia gravis: results in 153 validated cases and 2967 diagnostic assays. J Neurol Neurosurg Psychiatry 1985; 48(12):1246–52.
• Farrugia ME, Jacob S, Sarrigiannis PG, Kennett RP. Correlating Extent of Neuromuscular Instability With Acetylcholine Receptor Antibodies. Muscle Nerve 2009; 39(4): 489-93.
• Lindstrom J. An assay for antibodies to human acetylcholine receptor in serum from patients with myasthenia gravis. Clin Immunol Immunopathol 1977; 7(1): 36–43.
• Konishi T, Nishitani H, Matsubara F, Ohta M. Myasthenia gravis: relation between jitter in single-fiber EMG and antibody to acetylcholine receptor. Neurology 1981; 31(4): 386 –92.
• Newsom-Davis J, Pinching AJ, Vincent A, Wilson SG. Function of circulating antibody to acetylcholine receptor in myasthenia gravis: investigation by plasma exchange. Neurology 1978; 28(3):266 –72.
• Tindall RS. Humoral immunity in myasthenia gravis: biochemical characterization of acquired antireceptor antibodies and clinical correlations. Ann Neurol 1981;10(5): 437– 47.
• Cui LY, Guan YZ, Wang H, Tang X. Single fiber electromyography in the diagnosis of ocular myasthenia gravis: Report of 90 cases. Chin Med J (Engl) 2004;117(6): 848-51.
• Stálberg E, Sanders DB, Ali S, Cooray G, Leonardis L, Löseth S, et al. Reference values for jitter recorded by concentric needle electrodes in healthy controls: a multicenter study. Muscle Nerve 2016; 53(3): 351-62.
• Sanders DB, Arimura K, Cui L, Ertaş M, Farrugia ME, Gilchrist J, et al. Guidelines for single fiber EMG. Clin Neurophysiol 2019; 130(8): 1417-39.
• Stálberg E, Sanders DB, Kouyoumdjian JA. Pitfalls and Errors in Measuring Jitter. Clin Neurophysiol 2017; 128(11): 2233-41.