neostigmine(新斯的明)

myastheniagravis(MG)Speaker:LiXianzheMembers:WangFuhai,WangDefeng,GuoXiuquan,WangZhuqing,ChenWeiwei,ZhuYoukang,YuanMingzhenDEFINITIONMyastheniagravisisanautoimmunediseasethataffectsthetransmissionofsignalsfromnervestomuscles.AChRisonekindmultifunctionaltransmembraneglycoprotein,becomposedof5subunits,subalphaunitamongthemisthemainantigenthatbindswithanti-AchR.SubalphaunitofAchRisalsoantigendeterminantthatbindswithTcells.communicationsbreakdownbetweennervesandmuscles.WhatcauseMG?MechanismofMGHICMIAbnormalThymusHI1.antibodiesblockordestroymanyreceptorsitesforacetylcholineinmuscles.2.Destructionofthemusclemembraneasaresultofcomplementactivationbyautoantibodies3、OpsonizationofAnti-AChR4、OthersCMIAChRisakindofTD-AgInMGpatientsTcellskilltheAChRofThymusandmusclesdirectly.AbnormalThymusImmunetoleranceisbrokenbyabnormalthymuspositiveandnegativeselectionSymptoms?WeaknessoftheeyemusclesChangeinfacialexpressionDifficultyinswallowingandshortnessofbreathWeaknessinarms,hands,fingers,legs,andneckTreatmentTreatmentofMGMedicationscholinesteraseinhibitorssuchasneostigmine(新斯的明)andpyridostigmine(吡啶斯的明).Immunosuppressivedrugssuchasprednisone（强的松）cyclosporine(环孢菌素),andazathioprine（硫唑嘌呤）Thymectomythesurgicalremovalofthethymusgland(abnormalinmostpersonswithMG).Plasmapheresisorplasmaexchange.High-doseintravenousimmuneglobulin.王军，男，45岁，2000年患甲亢，随后出现眼睑下垂，一直以来当作甲亢症状治疗，经过治疗，甲亢的其他症状消失，检查也正常，但眼部症状却未能缓解。患者于2001年出现复视，挣眼无力，劳累后加重，一次偶然的机会，他从网上发现，他眼睛的症状与重症肌无力的首发症状很相似，他立即上当地医院检查，果然诊断为眼肌型重症肌无力，睑裂明显减小，在采用嗅化吡啶斯的明治疗后病情有所好转，但一感冒病情就加重，继而出现了胸闷气短、双上肢抬举费力，腰膝酸软等症状。