Gude Neil M, Stevenson Janet L, Sheehan Penelope M, Brennecke Shaun P
Royal Women's Hospital, Parkville, Victoria, Australia ; University of Melbourne, Parkville, Victoria, Australia.
Royal Women's Hospital, Parkville, Victoria, Australia.
J Investig Med High Impact Case Rep. 2013 Oct 23;1(4):2324709613509988. doi: 10.1177/2324709613509988. eCollection 2013 Oct-Dec.
Background. High prevalence of autoantibodies to the calcium-binding, endoplasmic reticulum chaperone protein calreticulin has been reported in various autoimmune and parasitic diseases. It has been reported that adenomyosis is associated with the presence of autoantibodies, in particular to phospholipids; however, it is not known whether it is associated with autoimmunity to calreticulin. Results. A 35-year-old gravida 4 para 4 woman presented with a history of many years of intractable menorrhagia. Histopathological examination of a subsequent hysterectomy specimen revealed a bulky uterus, a poorly developed secretory endometrium with decidualization of the stroma and chronic endometritis, as well as the presence of adenomyosis uteri. IgG autoantibodies to calreticulin were measured in the plasma of this and 234 other patients. Nine (3.8%) patients tested positive. The titer of anticalreticulin IgG autoantibody in the sole case with adenomyosis was approximately 8 times the average of other positive-testing samples. Conclusions. The etiology of adenomyosis is unclear. The presence of a high titer, blocking anticalreticulin autoantibody may directly increase the risk that adenomyosis might develop. It is also possible that the expansion of endometrial glandular tissue, as well as elevated estrogens, during adenomyosis may lead to elevated calreticulin, which induces an autoimmune reaction to it. Further study is required to determine whether there is a significant association between adenomyosis and the prevalence of calreticulin autoantibodies.
背景。在各种自身免疫性疾病和寄生虫病中，均有关于内质网钙结合伴侣蛋白钙网蛋白自身抗体高患病率的报道。据报道，子宫腺肌病与自身抗体的存在有关，尤其是与磷脂自身抗体有关；然而，尚不清楚它是否与针对钙网蛋白的自身免疫有关。结果。一名35岁、孕4产4的女性，有多年难治性月经过多病史。随后子宫切除标本的组织病理学检查显示子宫体积增大，分泌期子宫内膜发育不良，间质蜕膜化，存在慢性子宫内膜炎，以及子宫腺肌病。在该患者及其他234例患者的血浆中检测了针对钙网蛋白的IgG自身抗体。9例（3.8%）患者检测呈阳性。唯一患有子宫腺肌病的患者中抗钙网蛋白IgG自身抗体滴度约为其他阳性检测样本平均值的8倍。结论。子宫腺肌病的病因尚不清楚。高滴度、阻断性抗钙网蛋白自身抗体的存在可能直接增加子宫腺肌病发生的风险。也有可能在子宫腺肌病期间子宫内膜腺组织的扩张以及雌激素水平升高导致钙网蛋白升高，从而引发针对它的自身免疫反应。需要进一步研究以确定子宫腺肌病与钙网蛋白自身抗体患病率之间是否存在显著关联。
