Samoilova H. Clinical - neurophysiological and immunological aspects of diagnosis and prognosis of various forms of myasthenia gravis

The research was conducted by analyzing data of a comprehensive examination of 102 persons aged 18 to 69 years with myasthenia gravis. In view of the purpose of the study, according to spiral CT of chest organs, patients with myasthenia gravis were divided into three groups. The first group (M) consisted of 35 patients with myasthenia gravis without structural defects of the thymus. The second group (MH) consisted of 37 patients with myasthenia gravis and hyperplasia of the thymus. The third group (MT) consisted of 30 patients with myasthenia gravis on the background thymoma. In dissertation work for the first time was established clinical-neurophysiological and immunological features of myasthenia different forms depending on the structural changes in the thymus. It was determined that myasthenia in the absence of structural thymus changes debuted at the age of 40, characterized by predominant lesion of skeletal muscle and mild course (in 60% of cases the severity of the disease was 12.7 ± 1.76 points on the QMGS scale). Myasthenia gravis with thymus hyperplasia manifested in women at an earlier age than men, characterized by a predominance of local forms and moderate course (in 76.7 % of cases corresponds IIB class according MGFA classification and 19.2 ± 2.4 scores on a QMGS scale). Myasthenia gravis in patients with thymoma debuted after 40 years regardless of sex, manifests generalized muscle weakness and severe course (in 68.4 % of patients the severity of the disease was 31.68 ± 3.76 points on the QMGS scale).For the first time demonstrated a close relationship EMG-increase rate decrement test with worsening severity of the disease in all groups, indicating that the diagnostic and prognostic significance of EMG-index. It was established that the criteria for the severity of myasthenia are disturbances in the system of non-specific resistance factors and the imbalance of expression of CD + differentiation clusters in subpopulations of T- and B-lymphocytes that have different orientations and depend on structural changes in the thymus. Myasthenia without structural thymus disorders is characterized by the development of secondary immunodeficiency and inflammatory processes, myasthenia with thymic hyperplasia - the development of hypersensitivity type II, which is reflected by the negative role of cytotoxicity and excessive production of cytokines in the pathogenesis of this form of the disease. Myasthenia against the background of thymomas is characterized by cytotoxicity, activation of inflammatory processes and development of immunodeficiency state. First time proposed using CD31 + expression parameter for predicting the size of tumors in the thymus of patients with myasthenia combined with thymoma.