Feltkamp T E
Netherlands Ophthalmic Research Institute, Amsterdam.
Int Ophthalmol. 1990 Oct;14(5-6):327-33. doi: 10.1007/BF00163552.
The association between HLA-A29 and birdshot chorioretinopathy is the strongest of all associations between HLA and disease. Determination of HLA-A29 is even of diagnostic significance. The association between HLA-B27 and acute anterior uveitis (AAU) is much weaker, but B27 positive AAU may be considered as a distinct clinical entity. B27 positive patients with AAU should be referred to a rheumatologist, because half of these patients have ankylosing spondylitis or Reiter's syndrome. The determination of HLA-Bw51 is of limited but significant diagnostic value for the diagnosis of Behçet's disease. The present article shows how HLA determinations can serve as diagnostic tests. It is explained how the sensitivity and specificity of such tests can be used to calculate the influence of positive or negative results on the probability of the diagnosis. The structure and function of HLA class I molecules is now known to a great extent. This may lead to a better understanding of the pathogenic role of HLA-A29, HLA-B27, HLA-Bw51 and other HLA molecules which are associated with uveitis.
HLA - A29与鸟枪弹样脉络膜视网膜病变之间的关联是HLA与疾病之间所有关联中最强的。HLA - A29的检测甚至具有诊断意义。HLA - B27与急性前葡萄膜炎（AAU）之间的关联要弱得多，但B27阳性的AAU可被视为一种独特的临床实体。B27阳性的AAU患者应转诊给风湿病学家，因为这些患者中有一半患有强直性脊柱炎或赖特综合征。HLA - Bw51的检测对贝赫切特病的诊断具有有限但重要的诊断价值。本文展示了HLA检测如何用作诊断试验。文中解释了如何利用此类检测的敏感性和特异性来计算阳性或阴性结果对诊断概率的影响。目前人们对HLA I类分子的结构和功能已有很大程度的了解。这可能有助于更好地理解HLA - A29、HLA - B27、HLA - Bw51以及其他与葡萄膜炎相关的HLA分子的致病作用。
