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Die Bedeutung der Bestimmung von Antikörpern gegen Acetylcholinreceptoren in der Diagnostik der Myasthenia gravis

The significance of determining antibodies to acetylcholine receptor in myasthenia gravis

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Summary

The sera of 65 patients with myasthenia gravis (MG) were analysed for antibodies against the nicotinic acetylcholine receptor (ACh-R) using an immunoprecipitation assay (125I-α-bungarotoxin bound to human ACh-R as antigen). In 91% of MG sera elevated antibody titers were found ranging up to 500 times reference values. A control group of 77 patients showing various autoimmunological phenomena had ACh-R antibody concentrations within the reference range. The demonstration of antibodies against ACh-R provides a sensitive and highly specific tool for the diagnosis of MG. In addition, the test is helpful in following patients under treatment with immunosuppressive drugs or plasmapheresis. Antibodies against striated, smooth, or heart muscle (indirect immunofluorescence test) are much less sensitive and nonspecific for the diagnosis of MG.

Zusammenfassung

Bei 65 Patienten mit Myasthenia gravis (MG) wurden Antikörper gegen Acetylcholin-Receptoren (ACh-R) in der IgG-Fraktion des Patienten-Serums bestimmt (Immunpräzipitations-Assay mit125Jod-α-Bungarotoxin und menschlichem ACh-R als Antigen). Bei 91% der Patienten zeigte sich eine erhöhte Antikörper-Konzentration bis zum 500fachen des oberen Referenzbereichs. Eine Kontrollgruppe von 77 Patienten mit anderen gesicherten Autoimmunerkrankungen oder positiven Antikörpern gegen Muskulatur wies in keinem Fall erhöhte ACh-R-Antikörper-Konzentrationen auf. Damit ist der in-vitro Nachweis von ACh-R-Antikörpern ein empfindlicher und hochspezifischer Test für die Diagnostik der MG. Der Test eignet sich ebenfalls für die Verlaufskontrolle unter Therapie mit Immunsuppressiva oder Plasmapherese. Immunfluoreszenz-Untersuchung auf Antikörper gegen Muskelgewebe ist für die MG-Diagnostik weniger empfindlich und nicht spezifisch.

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Article 02 May 2019

Nils Erik Gilhus, Socrates Tzartos, … Jan J. G. M. Verschuuren

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Authors and Affiliations

  1. Neurologische Klinik und Poliklinik der Technischen Universität München, Germany

    K. V. Toyka, U. A. Besinger & K. L. Birnberger

  2. Institut für Klinische Chemie am Klinikum Großhadern, Ludwig-Maximilians-Universität München, Germany

    T. Becker, A. Fateh-Moghadam, D. Neumeier & K. Heininger

  3. III. Medizinische Klinik am Klinikum Großhadern der Ludwig-Maximilians-Universität München, Germany

    G. Brehm

Authors
  1. K. V. Toyka
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  2. T. Becker
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  3. A. Fateh-Moghadam
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  4. U. A. Besinger
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  5. G. Brehm
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  6. D. Neumeier
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  7. K. Heininger
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  8. K. L. Birnberger
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Herrn Prof. Dr. A. Struppler zum 60. Geburtstag gewidmet

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Toyka, K.V., Becker, T., Fateh-Moghadam, A. et al. Die Bedeutung der Bestimmung von Antikörpern gegen Acetylcholinreceptoren in der Diagnostik der Myasthenia gravis. Klin Wochenschr 57, 937–942 (1979). https://doi.org/10.1007/BF01478550

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  • DOI: https://doi.org/10.1007/BF01478550

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