Orbach Hedi, Zandman-Goddard Gisele, Amital Howard, Barak Vivian, Szekanecz Zoltan, Szucs Gabriella, Danko Katalin, Nagy Endre, Csepany Tunde, Carvalho Jozelio F, Doria Andrea, Shoenfeld Yehuda
Department of Medicine B, Wolfson Medical Center, Holon, Israel.
Ann N Y Acad Sci. 2007 Aug;1109:385-400. doi: 10.1196/annals.1398.044.
The development of autoimmune diseases may be influenced by hormonal, immunomodulatory, and metabolic pathways. Prolactin (PRL), ferritin, vitamin D, and the tumor marker tissue polypeptide antigen (TPA) were measured in autoimmune diseases: systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis (PM), dermatomyositis (DM), multiple sclerosis (MS), autoimmune thyroid diseases, and antiphospholipid syndrome. Hyperprolactinemia (HPRL) was detected in 24% of PM patients, in 21% of SLE patients, in 6.7% of MS patients, 6% of RA patients, and in 3% of SSc patients. Hyperferritinemia was detected in 23% of SLE patients, 15% of DM patients, 8% of MS patients, and 4% of RA patients. The patients had relatively low levels of 25 OH Vitamin D: the average results (mean +/- SD) were between 9.3 +/- 4.4 to 13.7 +/- 7.1 ng/mL in the different diseases, while the 25 OH Vitamin D concentrations less than 20 ng/mL are regarded as deficient. TPA levels were in the same range of the controls, elevated only in SLE. HPRL, hyperferritinemia, hypovitaminosis D, and TPA levels did not correlate with SLE activity elevated levels of rheumatoid factor or anti-CCP antibodies in RA. HPRL, hyperferritinemia, and hypovitaminosis D have different immunological implications in the pathogenesis of the autoimmune diseases. Preventive treatment with vitamin D or therapy for HPRL with dopamine agonists, may be considered in certain cases. Hyperferritinemia may be used as an acute-phase reactant marker in autoimmune diseases mainly SLE. TPA may be used to indicate the tendency for malignancies.
自身免疫性疾病的发展可能受激素、免疫调节和代谢途径的影响。对自身免疫性疾病患者检测了催乳素(PRL)、铁蛋白、维生素D和肿瘤标志物组织多肽抗原(TPA),这些疾病包括系统性红斑狼疮(SLE)、系统性硬化症(SSc)、类风湿关节炎(RA)、多发性肌炎(PM)、皮肌炎(DM)、多发性硬化症(MS)、自身免疫性甲状腺疾病和抗磷脂综合征。在24%的PM患者、21%的SLE患者、6.7%的MS患者、6%的RA患者和3%的SSc患者中检测到高催乳素血症(HPRL)。在23%的SLE患者、15%的DM患者、8%的MS患者和4%的RA患者中检测到高铁蛋白血症。患者的25-羟基维生素D水平相对较低:不同疾病的平均结果(均值±标准差)在9.3±4.4至13.7±7.1 ng/mL之间,而25-羟基维生素D浓度低于20 ng/mL被视为缺乏。TPA水平与对照组处于同一范围,仅在SLE中升高。HPRL、高铁蛋白血症、维生素D缺乏症和TPA水平与SLE活动、RA中类风湿因子或抗环瓜氨酸肽抗体水平升高无关。HPRL、高铁蛋白血症和维生素D缺乏症在自身免疫性疾病的发病机制中具有不同的免疫学意义。在某些情况下,可考虑用维生素D进行预防性治疗或用多巴胺激动剂治疗HPRL。高铁蛋白血症可作为自身免疫性疾病(主要是SLE)的急性期反应标志物。TPA可用于指示恶性肿瘤的倾向。