Department of Pneumology, Gdansk Medical University, Gdansk, Poland.
Adv Exp Med Biol. 2013;756:229-37. doi: 10.1007/978-94-007-4549-0_29.
Infectious, genetic factors, and autoimmunity have been considered as potential causes of sarcoidosis (SA). Pathological similarities between SA and tuberculosis (TB) suggest M. tuberculosis antigen(s) as causative agent(s). Our published comparative analysis of the human leukocyte antigens (HLA) system in patients with SA or TB in the same ethnic group revealed that some antigens were connected with high risk of developing of SA or TB, but other were comparable in both patient populations. Is it possible that the predominating occurrence of HLA antigens characteristic for TB may cause tuberculosis in patients with SA? To answer this question we evaluated the HLA class I and II alleles frequency by PCR amplification with sequence-specific primers in three women with histopathologically proven pulmonary SA, who developed bacteriologically confirmed TB on a corticosteroids (CS) therapy. Analysis of HLA in every case separately revealed a trend for higher occurrence of both alleles predisposing and protecting from TB than SA, in comparison with healthy individuals in our previously mentioned HLA genotyping study. Overall, the number of alleles predisposing to TB was statistically greater than the number of alleles connected with a high risk of developing SA. Also, the frequency of protecting alleles was statistically higher for TB than for SA. Therefore, SA in these patients developed at first, and the presence of additional environmental factors, e.g., age, CS might decrease an immune response and provoked TB. There is a possibility that the occurrence of HLA antigen more associated with high risk of developing TB than SA causes the development of tuberculosis in our patients with sarcoidosis.
感染、遗传因素和自身免疫被认为是结节病 (SA) 的潜在原因。SA 与结核病 (TB) 的病理相似性表明结核分枝杆菌抗原 (s) 是致病因子。我们之前对同一族群中 SA 或 TB 患者的人类白细胞抗原 (HLA) 系统进行了比较分析，结果显示，一些抗原与 SA 或 TB 发病的高风险相关，但其他抗原在两种患者群体中是可比的。是否有可能 SA 患者中占主导地位的 TB 特征 HLA 抗原会导致结核病？为了回答这个问题，我们在三位经组织病理学证实患有肺 SA 的女性中，通过聚合酶链反应（PCR）扩增和序列特异性引物评估了 HLA 类 I 和 II 等位基因的频率，这些女性在皮质类固醇（CS）治疗期间发生了细菌学确诊的 TB。对每个病例的 HLA 分析显示，与我们之前 HLA 基因分型研究中健康个体相比，两种与 TB 易感性和保护性相关的等位基因发生的几率更高。总体而言，与 SA 相比，TB 易感性等位基因的数量更多。此外，TB 的保护性等位基因的频率也高于 SA。因此，这些患者首先出现 SA，而年龄、CS 等其他环境因素的存在可能会降低免疫反应并引发 TB。有可能是与 TB 发病风险相关的 HLA 抗原的发生多于与 SA 相关的 HLA 抗原，导致了我们的 SA 患者发生结核病。
