Felisberto Mariano, Jorge Alex Sandro, Menolli Rafael Andrade, Gnutzmann Laísa Vieira, Nesi Vanessa
Laboratório de Análises Clínicas do Hospital Universitário do Oeste do Paraná, Florianópolis, SC, Brasil.
Universidade Estadual do Oeste do Paraná (Unioeste), Florianópolis, SC, Brasil.
Rev Bras Reumatol. 2015 Mar-Apr;55(2):181-4. doi: 10.1016/j.rbr.2014.01.012. Epub 2014 Oct 5.
Female patient, complaining of weakness and pain in hypogastric, was admitted to the emergency department of the University Hospital of the West of Paraná (HUOP). During the interview reported treatment of chronic infection with hepatitis C virus (HCV) with peginterferon and ribavirin. Among the laboratory tests ordered, the search for self-antibodies against cellular antigens, traditionally known as antinuclear factor, showed fluorescence shaped like rods and/or rings in the cytoplasm of cells. This study attempts to clarify the relationship between this pattern not yet completely understood and the clinical picture of the patient. This pattern is characterized by 3-10 μm rods or rings with 2-5 μm in diameter scattered throughout the cytoplasm of the cell. Therefore, this new standard has been designated as "rods and rings" (RR). The antigenic target of this reaction was identified as inosine-5'-monophosphate dehydrogenase type 2 (IMPDH2) which is a key enzyme in the synthesis of purine nucleotides. The IMPDH2 enzyme aggregated or modified shaped RR in those patients treated with ribavirin may become antigenic and induce an autoimmune response. It is possible that interferon alpha stimulates the occurrence of anti-RR reactivity apparently induced by ribavirin. So far it is not known why the standard RR in HEp2 cells occurs only in a fraction of patients with HCV. Previous studies presented in this paper allow affirming that these antibodies associated with the standard RR are strongly related to hepatitis C. Moreover, it can be stated that the occurrence of anti-RR reactivity is promoted by combination therapy with interferon and ribavirin.
一名女性患者因下腹部虚弱和疼痛前来巴拉那西部大学医院（HUOP）急诊科就诊。在问诊过程中，患者报告曾使用聚乙二醇干扰素和利巴韦林治疗丙型肝炎病毒（HCV）慢性感染。在所进行的实验室检查中，针对细胞抗原的自身抗体检测（传统上称为抗核因子检测）显示，细胞胞质中出现了棒状和/或环状荧光。本研究旨在阐明这种尚未完全理解的模式与患者临床表现之间的关系。这种模式的特征是，3 - 10μm的棒状或环状结构，直径为2 - 5μm，分散在细胞胞质中。因此，这种新的标准被命名为“棒状和环状”（RR）。该反应的抗原靶点被确定为肌苷-5'-单磷酸脱氢酶2型（IMPDH2），它是嘌呤核苷酸合成中的关键酶。在接受利巴韦林治疗的患者中，IMPDH2酶聚集或形成RR样的修饰形式可能会变得具有抗原性并引发自身免疫反应。α干扰素可能会刺激由利巴韦林明显诱导的抗RR反应性的出现。目前尚不清楚为什么HEp2细胞中的RR标准仅在一部分HCV患者中出现。本文中呈现的先前研究表明，与RR标准相关的这些抗体与丙型肝炎密切相关。此外，可以说干扰素和利巴韦林联合治疗会促进抗RR反应性的出现。
