The role of HTLV‐I in tropical spastic paraparesis in jamaica
The role of HTLV‐I in tropical spastic paraparesis in jamaica
复制标题
HTLV-I 在牙买加热带痉挛性截瘫中的作用
作者：
P. Rodgers;O. Morgan;C. Mora;P. Sarin;M. Ceroni;P. Piccardo;R. Garruto;C. Gibbs;D. Gajdusek
我们报告的47个本地出生的牙买加地方性热带痉挛性下肢轻瘫和1例热带共济失调性神经病患者的临床和实验室调查。平均发病年龄为40岁，女性男性占优势（2.7：1）。地方性热带痉挛性下肢轻瘫的神经学特征主要是痉挛性下肢轻瘫伴不同程度的本体感觉和/或浅表感觉障碍。使用酶联免疫吸附试验（ELISA），82%的血清和77%的脑脊液中存在人嗜T淋巴细胞病毒I型（HTLV‐I）的IgG抗体。免疫印迹分析，IgG抗体检测p19和p24 gag编码的核心蛋白在血清和脑脊液中。ELISA检测血清中的滴度比脑脊液中的滴度高10倍，并且在血清中未观察到液体中存在的一些寡克隆条带。血清-脑脊液白蛋白比值正常，IgG指数表明鞘内IgG合成。组织学变化显示慢性炎症反应，单核细胞浸润，血管周围袖状和脱髓鞘，主要是在侧柱。在1例患者中，从脊髓液中分离出一种在电子显微镜下与HTLV‐I形态相似的逆转录病毒。我们的研究表明，牙买加的地方性热带痉挛性下肢轻瘫是一种逆转录病毒相关的脊髓病，HTLV-I或抗原相似的逆转录病毒是致病因子。
We report clinical and laboratory investigations of 47 native‐born Jamaican patients with endemic tropical spastic paraparesis and of 1 patient with tropical ataxic neuropathy. Mean age at onset was 40 years, with a female‐male preponderance (2.7:1). Neurological features of endemic tropical spastic paraparesis are predominantly those of a spastic paraparesis with variable degrees of proprioceptive and/or superficial sensory impairment. Using enzymelinked immunoabsorbent assay (ELISA), IgG antibodies to human T‐lymphotropic virus type I (HTLV‐I) were present in 82% of sera and 77% of cerebrospinal fluids. On Western blot analysis, IgG antibodies detected the p19 and p24 gagencoded core proteins in both serum and cerebrospinal fluid. Titers were tenfold higher by ELISA in serum than in cerebrospinal fluid, and some oligoclonal bands present in fluid were not seen in serum. Serum–cerebrospinal fluid albumin ratios were normal, and IgG indexes indicated intrathecal IgG synthesis. Histopathological changes showed a chronic inflammatory reaction with mononuclear cell infiltration, perivascular cuffing, and demyelination that was predominant in the lateral columns. In 1 patient, a retrovirus morphologically similar to HTLV‐I on electron microscopy was isolated from spinal fluid. Our investigations show that endemic tropical spastic paraparesis in Jamaica is a retrovirus‐associated myelopathy and that HTLV‐I or an antigenically similar retrovirus is the causal agent.