Cunnane G, Whitehead A S
Division of Rheumatology, University of California, San Francisco 94143, USA.
Baillieres Best Pract Res Clin Rheumatol. 1999 Dec;13(4):615-28. doi: 10.1053/berh.1999.0049.
Amyloidosis refers to the extracellular accumulation of amyloid fibrils, derived from a circulating precursor, in various tissue and organs. The most common form of amyloidosis worldwide is that which occurs secondary to chronic inflammatory disease, particularly rheumatoid arthritis. The precursor molecule is serum amyloid A (SAA), an acute phase reactant, which can be used as a surrogate marker of inflammation in many diseases. SAA has a number of immunomodulatory roles, can induce chemotaxis and adhesion molecule expression, has cytokine-like properties and can promote the upregulation of metalloproteinases. It enhances the binding of high density lipoprotein to macrophages and thus helps in the delivery of lipids to sites of injury for use in tissue repair. It is thus thought to be an integral part of the disease process. Moreover, elevated levels of SAA over time predispose to secondary amyloidosis. Pathogenic factors underlying this disease are outlined along with guidelines for diagnosis and management.
淀粉样变性是指源自循环前体的淀粉样原纤维在各种组织和器官中的细胞外积聚。全球最常见的淀粉样变性形式是继发于慢性炎症性疾病，尤其是类风湿性关节炎的那种。前体分子是血清淀粉样蛋白A（SAA），一种急性期反应物，在许多疾病中可用作炎症的替代标志物。SAA具有多种免疫调节作用，可诱导趋化性和黏附分子表达，具有细胞因子样特性，并可促进金属蛋白酶的上调。它增强高密度脂蛋白与巨噬细胞的结合，从而有助于将脂质输送到损伤部位以供组织修复使用。因此，它被认为是疾病过程中不可或缺的一部分。此外，随着时间的推移，SAA水平升高易引发继发性淀粉样变性。本文概述了该疾病的致病因素以及诊断和管理指南。
