Ishioka S, Yamakido M
Second Department of Internal Medicine, Hiroshima University School of Medicine.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Jan;28(1):80-5.
The most reliable method for a diagnosis of sarcoidosis is histological examinations. However, compatible histological findings were detected among 60% of cases and 40% of cases was diagnosed by clinical evidence only (Clinical sarcoidosis). We assessed the diagnostic reliability of the cases based on clinical features only with a comparison of positivity between definite and clinical sarcoidosis for different clinical examinations. Chest X-ray, ACE, PPD skin test etc., % positivity of BHL, ACE, PPD skin test and 67Ga scan were positive in more than 80% of definite cases but only 50% in clinical cases except for 67Ga scan. This finding means that it is necessary to develop new clinical laboratory methods to diagnose clinical sarcoidosis. From these points of view, we prepared a monoclonal antibody (IHY-1) to the sarcoid granulomagenic agent contained in Kveim suspension by immunizing mice with Kveim suspension. IHY-1 is an IgM monoclonal antibody that did not react with erythrocytes, lymphocytes, monocytes, alveolar macrophages or macrophage derived cell lines. It reacted with granuloma epithelioid cells of sarcoidosis-affected lymph nodes. Also in the granuloma of cases accompanied by tuberculosis, the monoclonal antibody positively reacted with epithelioid cells although the reaction was not strong.
结节病最可靠的诊断方法是组织学检查。然而，60%的病例检测到符合的组织学表现，40%的病例仅通过临床证据确诊（临床结节病）。我们仅基于临床特征评估了病例的诊断可靠性，比较了确诊结节病和临床结节病在不同临床检查中的阳性率。胸部X线、血管紧张素转换酶（ACE）、结核菌素皮肤试验等，双侧肺门淋巴结肿大（BHL）、ACE、结核菌素皮肤试验及镓-67扫描的阳性率在超过80%的确诊病例中呈阳性，但在临床病例中除镓-67扫描外仅为50%。这一发现意味着有必要开发新的临床实验室方法来诊断临床结节病。从这些角度出发，我们用Kveim悬液免疫小鼠，制备了针对Kveim悬液中结节病肉芽肿形成因子的单克隆抗体（IHY-1）。IHY-1是一种IgM单克隆抗体，不与红细胞、淋巴细胞、单核细胞、肺泡巨噬细胞或巨噬细胞衍生细胞系发生反应。它与结节病受累淋巴结的肉芽肿上皮样细胞发生反应。在伴有结核病的病例肉芽肿中，该单克隆抗体也与上皮样细胞呈阳性反应，尽管反应不强。
