Michels A W, Eisenbarth G S
Department of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Aurora, Colorado 80045, United States.
J Intern Med. 2009 May;265(5):530-40. doi: 10.1111/j.1365-2796.2009.02091.x.
Autoimmune polyendocrine syndromes type 1 and 2 (APS-1 and APS-2) are diverse in regards to their component diseases and immunologic features of pathogenesis. Animal models and human studies highlight the importance of alleles of HLA (human leukocyte antigen)-like molecules determining tissue specific targeting that with the loss of tolerance leads to organ specific autoimmunity. Knowledge of the syndromes and component diseases allows clinicians to recognize and prevent illness prior to morbidity. With the current understanding of the syndromes, a paradigm for diagnosis, screening and treatment can be established. Once genetically susceptible individuals are identified screening for autoantibodies can be performed. Amongst autoantibody positive individuals, monitoring for physiologic decompensation, with a goal of treating prior to morbidity and in some cases mortality, follows. With continued basic and clinical research, therapies aimed at treating the underlying autoimmunity and disease prevention should become possible.
1型和2型自身免疫性多内分泌综合征(APS-1和APS-2)在其组成疾病和发病机制的免疫学特征方面存在差异。动物模型和人体研究强调了HLA(人类白细胞抗原)样分子等位基因在决定组织特异性靶向方面的重要性,这种靶向作用随着耐受性的丧失会导致器官特异性自身免疫。了解这些综合征和组成疾病能使临床医生在发病前识别并预防疾病。基于目前对这些综合征的认识,可以建立诊断、筛查和治疗的范例。一旦确定了遗传易感性个体,就可以进行自身抗体筛查。在自身抗体呈阳性的个体中,要监测生理失代偿情况,目标是在发病前甚至在某些情况下在死亡前进行治疗。随着基础研究和临床研究的不断深入,针对潜在自身免疫和疾病预防的治疗方法应该是可行的。