The HLA antigen distribution and thyroid autoantibody status of 27 Chinese children in Hong Kong with juvenile onset myasthenia gravis have been compared with 110 healthy university students from the same population. Twenty-four of the patients had ocular myasthenia. There was a significantly increased prevalence of HLA BW46 in the patients compared with controls (67% vs 26.4%, p less than 0.005) indicating that BW46 confers a relative risk of 5.6 for juvenile onset myasthenia gravis in Chinese children. The increased prevalence of BW46 was not associated with thyroid autoimmunity in the patients although the antigen is known to be associated with thyrotoxicosis in Chinese. The possibility that BW46 confers protection against the development of acetyl-choline receptor antibodies in Chinese patients is discussed. One patient had the Caucasian antigen B8 and the question whether defective immune response genes were introduced into the Chinese through Caucasian admixture is raised.
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