Two-year outcome of thymectomy with or without immunosuppressive treatment in nonthymomatous myasthenia gravis and its effect on regulatory T cells
Jazyk angličtina Země Nizozemsko Médium print-electronic
Typ dokumentu časopisecké články, práce podpořená grantem
PubMed
26320610
DOI
10.1016/j.jns.2015.08.029
PII: S0022-510X(15)00525-0
Knihovny.cz E-zdroje
- Klíčová slova
- CD4(+) CD25(+) regulatory T-lymphocytes, Combined immunosuppressive treatment, Corticosteroids, Myasthenia gravis, Pyridostigmine, QMG score, Thymectomy,
- MeSH
- antigeny CD4 MeSH
- dospělí MeSH
- hodnocení výsledků zdravotní péče * MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- imunosupresiva terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- myasthenia gravis krev farmakoterapie chirurgie MeSH
- následné studie MeSH
- počet CD4 lymfocytů MeSH
- počet lymfocytů MeSH
- receptor interleukinu-2 - alfa-podjednotka MeSH
- regulační T-lymfocyty * MeSH
- thymektomie metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- antigeny CD4 MeSH
- hormony kůry nadledvin MeSH
- IL2RA protein, human MeSH Prohlížeč
- imunosupresiva MeSH
- receptor interleukinu-2 - alfa-podjednotka MeSH
BACKGROUND: Myasthenia gravis (MG) is the autoimmune disorder in which the thymus is considered the pathogenic organ. Thymectomy (TE) is a therapeutic option for MG and often ameliorates clinical symptoms. METHODS: We evaluated clinical features and outcomes after TE in patients without thymoma and the influence of TE with or without concomitant immunotherapy on the CD4(+)CD25(+) regulatory T cell subpopulation of lymphocytes in peripheral blood in defined followed groups of nonthymomatous MG patients. RESULTS: A total of 46 patients with generalized MG who underwent transsternal TE were identified. Neurologic outcomes after TE were favorable for the majority of patients mainly from the group treated with corticosteroids or combined immunosuppressive treatment. TEs with immunosuppressive treatment in MG patients were associated with increased percentages of CD4(+)CD25(+) cells (p<0.001). No significant change in the postoperative levels of CD4(+)CD25(+) cells was observed in thymectomized patients who preoperatively only received pyridostigmine. Also their clinical response to TE after 2 years of follow-up was worst of all followed groups. CONCLUSIONS: The exact mechanism by which TE ameliorates symptoms of MG is yet not clear. These observations indicate that increased percentages of CD4(+)CD25(+) T cells in MG may be related to disease stability and that TE and synergistic effect with concomitant, continuing immunotherapy augmented the proportion of CD4(+)CD25(+) T cells. On the basis of our observations TE alone is not enough to increase the number of circulating CD4(+)CD25(+) regulatory T cells and to establish complete stable remission.
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