McCarty G A
Ann Allergy. 1985 Sep;55(3):421-33.
Guidelines have been presented for the optimal selection and interpretation of various laboratory tests related to rheumatologic, immunologic, and allergic disorders. The last decade has witnessed many technologic changes in the performance of screening tests for autoantibodies, and an expeditious approach to the detection of the clinically useful autoantibody system has been outlined. When both an immunofluorescent assay using an actively dividing substrate such as HEp-2 and an immunodiffusion test for precipitin autoantibodies are performed on patient sera, it is likely that most of the significant diagnostic and prognostic systems will be detected. Although exact pathogenetic roles have not been defined for all autoantibodies, it is apparent that highly specific markers for certain rheumatic diseases exist and the pertinent clinical aspects of each individual autoantibody-autoantigen system has been summarized. Why so many autoantibodies are cross-reactive with seemingly unrelated antigens is a perplexing aspect of autoimmunity, a disease process for which the necessary and sufficient conditions of development have not been defined even after decades of research. One recent hypothesis regarding the generation of diverse autoantibodies is the tenet that production is interrelated in an auto-anti-idiotypic network. Support for this hypothesis comes from the recent successful use of anti-idiotypes to DNA autoantibodies in an attempt to abrogate pathogenetic effects of target organ damage in murine models of SLE. A similar approach might be undertaken with some of the other autoantibody systems in an attempt at a novel therapy for disorders of immunoregulation.
已经提出了关于与风湿性、免疫性和过敏性疾病相关的各种实验室检查的最佳选择和解读的指南。在过去十年中，自身抗体筛查试验的性能发生了许多技术变化，并且概述了一种快速检测临床上有用的自身抗体系统的方法。当对患者血清同时进行使用如HEp-2等活跃分裂底物的免疫荧光测定和针对沉淀素自身抗体的免疫扩散试验时，很可能会检测到大多数重要的诊断和预后系统。虽然并非所有自身抗体的确切致病作用都已明确，但显然存在某些风湿性疾病的高度特异性标志物，并且已经总结了每个单独的自身抗体 - 自身抗原系统的相关临床方面。为什么如此多的自身抗体与看似不相关的抗原发生交叉反应，这是自身免疫的一个令人困惑的方面，即使经过数十年的研究，这种疾病过程的发生所必需和充分的条件仍未明确。最近关于多种自身抗体产生的一种假说是，其产生在自身抗独特型网络中是相互关联的。对这一假说的支持来自最近在系统性红斑狼疮小鼠模型中成功使用针对DNA自身抗体的抗独特型抗体来消除靶器官损伤的致病作用。对于一些其他自身抗体系统，可能会采取类似的方法，尝试针对免疫调节紊乱进行新的治疗。
