High prevalence of Sjogren's syndrome in patients with HTLV-I associated myelopathy
High prevalence of Sjogren's syndrome in patients with HTLV-I associated myelopathy
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DOI：
10.1136/ard.56.3.167
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发表时间：
1997-03-01
影响因子：
27.4
通讯作者：
Nagataki, S
中科院分区：
文献类型：
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作者：
Nakamura, H;Eguchi, K;Nagataki, S
目的：在日本长崎，一个HTLV-I感染严重流行的地区，有报道称女性干燥综合征（SS）患者中HTLV-I的高血清阳性率。唾液伊加类抗体HTLV-I是常见的HTLV-I血清阳性SS患者。本研究旨在阐明HTLV-I感染引起SS的发病机制。方法：收集长崎大学医学院连续收治的10例HTLV-I相关性脊髓病（HAM）患者的SS的临床特征、组织学表现和血清自身抗体的检出率。与20例HTLV-I阳性和20例HTLV-I阴性的SS患者进行比较。这些患者也有腺体外表现，包括复发性葡萄膜炎、关节病、间质性肺炎、雷诺现象和炎症性肠病。所有HAM患者的组织学检查均显示唇腺有单核细胞浸润。10例患者中有6例有单核细胞浸润，病灶评分为1或更高。根据欧洲共同体提出的SS初步标准，6例患者确诊为SS，2例患者诊断为可能的SS。HAM患者血清丙种球蛋白和IgG值升高。HAM患者类风湿因子、抗核抗体和抗SS-A（Re）抗体的检出率低于HTLV-I阳性和阴性SS患者。然而，有没有显着差异，在HAM患者与明确的SS，HTLV-I血清阳性和HTLV-I血清阴性SS患者的这些抗体的患病率。CD 3（+）CD 4（+）T细胞在HAM患者唾液腺中的分布与HTLV-I阳性和阴性患者唾液腺中的分布相似。这似乎是可能的，从HAM患者的外周血单核细胞优先浸润到唾液腺，这些细胞产生的自身抗体以及抗-HTLV-I antibody.Conclusion -结果强烈支持的想法，HTLV-I参与疾病的发病机制中的一个子集的SS患者在流行地区。
Objective - A high seroprevalence of HTLV-I in female Sjogren's syndrome (SS) patients has been reported in Nagasaki, Japan, an area that is heavily endemic for HTLV-I infection. Salivary IgA class antibodies to HTLV-I were common among HTLV-I seropositive patients with SS. This study was undertaken to elucidate the pathogenesis of SS caused by HTLV-I infection.Methods - The clinical features and histological findings of SS and the prevalence of serum autoantibodies in 10 patients with HTLV-I associated myelopathy (HAM) who were consecutively admitted into Nagasaki University School of Medicine, were compared with those of 20 HTLV-I seropositive and 20 HTLV-I seronegative patients with SS.Results - Ocular and oral manifestations of SS were commonly detected in HAM patients. These patients also had extraglandular manifestations including recurrent uveitis, arthropathy, interstitial pneumonitis, Raynaud's phenomenon, and inflammatory bowel disease. All patients with HAM histologically showed a mononuclear cell infiltration in the labial salivary grands. Six of 10 patients had a mononuclear cell infiltration with a focus score of 1 or greater. According to the preliminary criteria for SS proposed by the European Community, definitive SS was diagnosed in six patients and probable SS in two patients. Serum gamma globulin and IgG values were increased in HAM patients. Patients with HAM had lower prevalence of rheumatoid factor, antinuclear antibody, and anti-SS-A (Re) antibody than those of HTLV-I seropositive and HTLV-I seronegative SS patients. However, there was no significant difference in the prevalence of these antibodies among HAM patients with definitive SS, HTLV-I seropositive and HTLV-I seronegative SS patients. The CD3(+)CD4(+) T cells preferentially infiltrated into the salivary glands in HAM patients as well as the salivary glands of patients with HTLV-I seropositive and seronegative patients. It seems probable that peripheral blood mononuclear cells from HAM patients preferentially infiltrated into the salivary glands, and that these cells produced the autoantibodies as well as anti-HTLV-I antibody.Conclusion - The results strongly support the idea that HTLV-I is involved in the pathogenesis of the disease in a subset of patients with SS in endemic areas.