Lee L A, Norris D A
University of Colorado School of Medicine, Denver.
Immunol Ser. 1989;46:359-86.
Cutaneous disease in lupus is clinically heterogeneous, and it is likely that mechanisms of disease are also heterogeneous. Nevertheless, in many cutaneous forms of lupus and in the systemic disease itself, there is compelling evidence that autoantibodies are involved. It is our belief that autoantibodies are of primary importance in the etiology of the cutaneous lupus lesions discussed in this chapter and that antibody specificities are critical in most cases in determining the clinical expression of disease. As discussed earlier, antibodies can effect tissue injury by several mechanisms. There is evidence that ADCC may be an important mechanism of keratinocyte cytotoxicity in cutaneous lesions characterized by antibody deposition and a mononuclear cell infiltrate. Vasculitic lesions that have an infiltrate of polymorphonuclear cells may be related to antibody- and complement-dependent neutrophil-mediated endothelial cytotoxicity. Ultraviolet light, sex steroids, and certain genes such as those of the major histocompatibility complex appear to be important modulating factors in lupus.
狼疮中的皮肤疾病在临床上具有异质性，疾病机制可能也存在异质性。然而，在许多皮肤型狼疮以及系统性疾病本身中，有令人信服的证据表明自身抗体参与其中。我们认为，自身抗体在本章所讨论的皮肤狼疮病变的病因中至关重要，并且在大多数情况下，抗体特异性对于确定疾病的临床表型至关重要。如前所述，抗体可通过多种机制导致组织损伤。有证据表明，在以抗体沉积和单核细胞浸润为特征的皮肤病变中，抗体依赖的细胞介导的细胞毒性（ADCC）可能是角质形成细胞细胞毒性的重要机制。有多形核细胞浸润的血管炎病变可能与抗体和补体依赖的中性粒细胞介导的内皮细胞毒性有关。紫外线、性类固醇以及某些基因，如主要组织相容性复合体的基因，似乎是狼疮中重要的调节因素。
