الفهرس 
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Abstract
MG is an autoimmune disease affecting the NMJ of skeletal muscles, leading to muscle weakness and fatigability. In the majority of cases, it is caused by antibodies against AChR and MuSK receptors; however, some MG patients have antibodies against agrin and its receptor (LRP4) which is critical for NMJ formation and maintenance. The current study was conducted to estimate the frequency of autoantibodies to LRP4 positivity in patients with MG with identification of the clinical characteristics of LRP4 antibodies positive MG patients. Also, it investigated the role of NLR in MG patients as a novel reliable indicator of systemic inflammatory status and disease activity. Fifty Patients with MG whom had been admitted at Neurology department, Mansoura university hospitals inpatient and outpatient clinics, had been diagnosed on the basis of clinical features and neurophysiological investigations were included in our study while we excluded current pregnant female patients, patients in myasthenic crisis, patients with any sort of cognitive impairment or mentally retarded and patients with muscle diseases other than MG. In addition, thirty healthy control subjects matching for age and sex with myasthenic patients were recruited into our study as a control group. After an informed consent was obtained from every subject, full general history was taken from all participants while neurological history was taken only from the group of patients. Also, general and neurological clinical examination & clinical tests for diagnosis of MG were done. Then patients were classified into stages according to the MGFA clinical classification. Also, we did an evaluation of the outcome and prognosis of MG patients by MGCS. Radiological evaluation was done for all patients using CT chest to identify the thymus gland. Also, electrophysiological studies of the NMJ was done for all patients using RNS. We used LRP4-Ab ELISA kit to assay LRP4-Ab levels in serum of both patients and control groups. In addition, NLR was calculated after the determination of the complete blood cell counts and differential counts of leukocytes for all subjects. The patients response to treatment was assessed by MGCS as a MG specific outcome indicator of clinical improvement. We found that 8.0% of our MG patients were positive for LRP4-Ab. LRP4 antibody positive MG appears to affect more women than men with younger age of onset. Mostly, it is associated with ocular MG or with mild-to-moderate symptoms of generalized MG with normal thymus, positive RNS, good response to therapy and better prognosis.