The pathogenesis of arthritis associated with acute hepatitis-B surface antigen-positive hepatitis. Complement activation and characterization of circulating immune complexes.
The pathogenesis of arthritis associated with acute hepatitis-B surface antigen-positive hepatitis. Complement activation and characterization of circulating immune complexes.
复制标题
关节炎的发病机制与急性乙型肝炎表面抗原阳性肝炎相关。
DOI：
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发表时间：
1975
影响因子：
15.9
通讯作者：
K. Isselbacher
中科院分区：
文献类型：
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作者：
J. Wands;E. Mann;E. Alpert;K. Isselbacher
循环免疫复合物被确定在冷冻蛋白分离的血清系列样品从6例急性病毒性肝炎和关节炎症状。通过血凝抑制和血凝法分析冷沉淀物中乙型肝炎表面抗原（HBsAg）和乙型肝炎表面抗体（抗-HBs）的存在。补体成分用反向电泳法检测，免疫球蛋白用凝胶扩散法检测。HBsAg，IgG和IgM被确定在所有肝炎患者的冷沉淀，但关节炎患者的浓度较高。只有冷沉淀从肝炎患者关节炎含有伊加和补体成分C3，C4和C5以及IgG和IgM，这消失的决议关节炎。这些冷沉淀物中IgG的亚型主要是补体固定IgG 1和IgG 3，与血清浓度相比，HBsAg和抗-HBs在冷沉淀物中浓缩数倍。在两名患者中进行的连续研究表明，抗-HBs在冷冻蛋白复合物中的最初出现与IgM复合物中的检测相关，表明对HBsAg的初次免疫应答。备解素复合物的C3激活片段（C3 A）被发现在新鲜血清中获得的三个肝炎关节炎患者，而不是在单纯性肝炎。关节炎患者的冷沉淀免疫复合物在体外将新鲜正常血清中的C3 PA转化为C3 A，而从无并发症的肝炎患者中分离的冷冻蛋白则没有这种效果。因此，急性肝炎关节炎患者循环补体固定免疫复合物的短暂出现与经典和替代补体途径的激活有关，并表明它们在这些血清病样肝外症状的发病机制中起重要作用。
Circulating immune complexes were identified in cryoproteins isolated from serial samples of serum from six patients with acute viral hepatitis with and without arthritic symptoms. Cryoprecipitates were analyzed for the presence of hepatitis-B surface antigen (HBsAg) and hepatitis-B surface antibody (anti-HBs) by hemagglutination inhibition and hemagglutination. Complement components were detected by counter electrophoresis, and immunoglobulins were detected by gel diffusion. HBsAg, IgG, and IgM were identified in cryoprecipitates from all hepatitis patients, but were higher in concentration in patients with arthritis. Only cryoprecipitates from hepatitis patients with arthritis contained IgA and complement components C3, C4, and C5 as well as IgG and IgM, which disappear with resolution of the arthritis. The subtypes of IgG in these cryoprecipitates were predominantly the complement-fixing IgG1 and IgG3, HBsAg and anti-HBs were concentrated several-fold in the cryoprecipitates when compared to the serum concentration. Sequential studies in two patients demonstrated that the initial appearance of anti-HBs in the cryoprotein complex was associated with the detection in the complex of IgM suggesting a primary immune response to HBsAg. The C3 activator fragment (C3A) of the properdin complex was found in fresh serum obtained from three hepatitis patients with arthritis and not in uncomplicated hepatitis. The cryoprecipitable immune complexes from patients with arthritis converted C3PA in fresh normal sera to C3A in vitro whereas cryoprotein isolated from patients with uncomplicated hepatitis had no such effect. Thus, the transient appearance of circulating complement-fixing immune complexes in patients with the arthritis of acute hepatitis is associated with activation of both classical and alternate complement pathways and suggests that they play an important role in the pathogenesis of these serum sickness-like extrahepatic symptoms.