双侧特发性急性前葡萄膜炎患者抗内毒素抗体水平升高。

Department of Ophthalmology, Wrocław Medical University, Wrocław, Poland.

Acta Ophthalmol. 2011 May;89(3):e283-8. doi: 10.1111/j.1755-3768.2010.01969.x.

PURPOSE

Endotoxins have been proved to be responsible for acute anterior uveitis (AAU) in animals in a well-established experimental model of endotoxin-induced uveitis (EIU). The purpose of our study was the detection of antibodies against endotoxins of selected enterobacteria in the serum of patients with idiopathic AAU and searching for correlations between the levels of these antibodies and the presence of HLA-B27 antigen as well as characteristic signs of EIU such as bilaterality and the absence of spontaneous recurrences of the disease.

METHODS

Reactions of serum IgG antibodies with lipopolysaccharides (LPSs) of Escherichia coli O1, E. coli O10, E. coli O111, E. coli J5, and Klebsiella pneumoniae O3 were determined for 60 patients with idiopathic AAU and 40 healthy volunteers. The presence of HLA-B27 antigen in patients was determined. Documentation of the frequency of recurrences of AAU during a follow-up period of 8 years was collected.

RESULTS

We have observed that the sera of patients with a first attack of AAU reacted stronger with the LPS of K. pneumoniae O3 than the sera of patients with relapse of the disease. Patients with bilateral AAU had markedly higher levels of antibodies against four of the five used LPSs than patients with one eye involved. A multiply comparison showed higher levels of IgG reacting with LPS of E. coli O111 in patients with bilateral eye inflammation admitted with the first attack of AAU comparing to controls. The incidence of recurrent form of AAU was significantly increased in HLA-B27-positive patients compared to HLA-B27-negative patients. However, we found in HLA-B27 carriers that those with the bilateral form of AAU had over three times smaller risk of recurrence and showed stronger immunization by endotoxins than patients with unilateral inflammation.

CONCLUSION

Our results suggest a potential role of endotoxins in the aetiology of the nonrecurrent bilateral form of AAU. We suggest that not only HLA-B27 status but also determination of number of involved eyes may be useful to assess the risk of recurrence of the idiopathic AAU.

目的

内毒素已被证明是动物实验性内毒素诱导性葡萄膜炎（EIU）模型中急性前葡萄膜炎（AAU）的罪魁祸首。本研究的目的是检测特定位点肠杆菌的内毒素抗体在特发性 AAU 患者血清中的存在，并寻找这些抗体的水平与 HLA-B27 抗原的存在之间的相关性，以及与 EIU 的特征性体征（如双侧性和疾病无自发复发）的相关性。

方法

检测 60 例特发性 AAU 患者和 40 例健康志愿者血清 IgG 抗体与大肠杆菌 O1、大肠杆菌 O10、大肠杆菌 O111、大肠杆菌 J5 和肺炎克雷伯菌 O3 的脂多糖（LPS）的反应。确定患者 HLA-B27 抗原的存在。收集 8 年随访期间 AAU 复发频率的记录。

结果

我们发现首次发作 AAU 的患者血清与 K. pneumoniae O3 的 LPS 反应强于疾病复发患者。双侧 AAU 患者对五种 LPS 中的四种的抗体水平明显高于单眼受累患者。多重比较显示，首次发作双侧 AAU 的患者与对照组相比，对 LPS 大肠杆菌 O111 的 IgG 反应水平更高。与 HLA-B27 阴性患者相比，HLA-B27 阳性患者复发性 AAU 的发生率显著增加。然而，我们发现 HLA-B27 携带者中，双侧 AAU 患者的复发风险降低了三倍，并且比单侧炎症患者对内毒素的免疫反应更强。