Clinical Investigation Of Hepatitis B Virus Infection In Patients With Myasthenia Gravis

Objective To analyze the serum hepatitis B virus(HBV)markers in patients with myasthenia gravis(MG),and to provide reference data for the further study of the relationship between MG and HBV infection..Method Statistical analysis of 92 patients with MG,107 cases of rheumatoid arthritis(RA)and 133 cases of non autoimmune diseases(NAD).The results of serum HBV markers and clinical manifestation in patients with NAD were compared with those other three groups.92 cases of MG patients were divided into two groups according to whether or not combined with thymoma,the difference of the serum HBV marker and clinical performance were compared between the two groups.Then the 92 MG patients were divided into three groups: early onset,late onset and very late onset group,according to the age of disease onset,the difference of serum HBV markers and clinical manifestation between the three groups were compared.In this study,77 of 92 MG patients were with the available serum ACh R-Ab test results.According to the results of ACh R-Ab positive or negative,the patients were divided into two groups: SPMG and SNMG.The differences of the serum HBV marker and the clinical presentation were compared between the two groups.The categorical data were analyzed using ?2 test.Normally distributed measurement data were presented as mean±standard deviation,and t-test was used to analyze the differences between two groups.The non-normal distribution measurement data was expressed in medians and analyzed using the Mann Whitney U test.Count data was presented as a rate,using ?2 test or Fisher's exact test,and P<0.05 is considered statistically significant.Results HBe Ab positive rate of three MG patients group were 10.9%,RA group 14.0%,NAD 23.3%,the difference was statistically significant(?2=6.914,P=0.032).HBc Ab positive rate of three MG patients were group 18.5%,RA group 31.8%,NAD 40.6% in the control group,the difference was statistically significant(?2 = 12.310,P = 0.002),wherein the positive rate was significantly lower than MG group HBc Ab NAD group(?2=12.324,P <0.001).Three groups of patients with HBs Ag,HBs Ab and the difference between HBe Ag positive rates were not statistically significant.In the subtypes of serum HBV markers,all the HBV markers negative rate were 51.1% in MG,51.4% in RA,48.9% in NAD,the difference between them was not statistically significant(?2=0.183,P=0.912).Only HBs Ab positive rate were that 30.4% in MG group,16.8% in RA group,10.5% in NAD control group,the difference between them statistically significant(?2=14.724,P=0.001),multiple comparisons proved that in MG and NAD groups,the data was statistically difference(?2=14.197,P<0.001).The present rate of HBV markers indicated HBV infection were18.5% of MG group,31.8% of RA group,40.6% of NAD group,the data of the three groups were statistically significant(?2=12.310,P=0.002),that in the MG group was significantly lower than in NAD(?2 =12.324,P<0.001).The 92 patients with MG were further divided into two groups based on whether combined with thymoma.There was no significant difference the two groups,whatever the the individual HBV or their subtypes.The same results achieved when the patients divided into three groups according the disease onset age,early onset,late onset and very late onset.There are 77 in the 92 MG patients detected the ACh R-Ab,according to the whether the patients carried on the ACh R Ab,the patients were divided into two groups SPMG and SNMG.The positive rate of HBe Ab of two groups were SPMG group 4.4%,SNGM group 21.9%,the difference was statistically significant(?2 =3.945,P=0.047),the positive rate of SPMG group was lower than that in group SNGM.The serum markers of HBV between test results and clinical symptoms were not statistically significant.Conclusion1? HBe Ab,HBc Ab positive rate were significant difference ampng the MG,RA,NAD patients,of which,HBc Ab positive rate in MG group was significantly lower than the NAD control group.It is suggested that the immune environment in MG patients may enhance the ability of the body to remove HBV and reduce the risk of HBV infection.2? The difference of only HBs Ab positive rate was statistically significant among MG,RA and NAD three groups,and the difference between MG group and NAD group was statistically significant.It is suggested that hepatitis B vaccination may be associated with autoimmune diseases such as MG,and the immune environment of MG patients may enhance the immune response of HBV vaccine.3? There were no statistically significant differences in serum individual HBV markers and clinical subtypes between the two groups of patients with thymoma and those without Thymoma in MG.and the same results achieved when compared the MG patients with early-onset,late-onset and very late onset groups.It is suggested that there is no significant correlation between the incidence of thymoma and the age of patients with HBV infection in MG patients.4? The difference of HBe Ab positive rate between SPMG and SNGM in MG patients was statistically significant,SPMG group was lower than that in SNGM group.It is concluded that patients with SPMG group have better clearance ability and lower risk of HBV infection than SNMG group,but need further study to confirm.The relationship between MG and HBV infection and its specific mechanism need to be further studied,meanwhile,the effect of immunosuppressive agent on the occurrence of viral infection in MG patients is worthy of attention and exploration.