Sawalha Amr H, Harley John B
Department of Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
Curr Opin Rheumatol. 2004 Sep;16(5):534-40. doi: 10.1097/01.bor.0000135452.62800.8f.
The production of autoantibodies against nuclear antigens is the hallmark of systemic lupus erythematosus. Among the large number of autoantibodies known, only a limited number appear to be clinically important. The various autoantibodies have different clinical significance in lupus patients. In this review, we will discuss the various antinuclear autoantibodies detected in lupus patients, their potential pathogenic role, and their usefulness in clinical practice.
Recent advances include the clear demonstration of autoantibody transport into living cells, a process that clearly includes interactions with a number of cellular components that may play a role in cellular dysfunction and disease. Also, the anti-Sm B/B' response originates from a single antigenic epitope that appears to be the same structure in different patients, before spreading to other epitopes and becoming the typically mature, complex humoral autoimmune anti-Sm autoantibody response.
The existing data strongly support a central role of autoantibodies in the pathogenesis of lupus. Better characterization of autoantibodies, their mechanisms of production, and their interactions with various cellular constituents will clarify the pathogenesis of this disease.
针对核抗原产生自身抗体是系统性红斑狼疮的标志。在已知的大量自身抗体中，只有少数似乎具有临床重要性。各种自身抗体在狼疮患者中具有不同的临床意义。在本综述中，我们将讨论在狼疮患者中检测到的各种抗核自身抗体、它们潜在的致病作用以及它们在临床实践中的用途。
最近的进展包括明确证明自身抗体可转运至活细胞内，这一过程显然涉及与许多可能在细胞功能障碍和疾病中起作用的细胞成分相互作用。此外，抗Sm B/B'反应起源于单个抗原表位，在不同患者中该表位似乎具有相同结构，之后扩散至其他表位并形成典型的成熟、复杂的体液自身免疫性抗Sm自身抗体反应。
现有数据有力支持自身抗体在狼疮发病机制中起核心作用。更好地描述自身抗体、其产生机制及其与各种细胞成分的相互作用将阐明该疾病的发病机制。
