Smail A, Ducroix J P, Tondriaux A, Sevestre H, Yzet T, Baillet J
Service de Médecine Interne, Centre Hospitalier et Universitaire, Hôpital Nord, Amiens.
Ann Med Interne (Paris). 1988;139(5):324-30.
Circulating immune complexes are thought to play an essential part in the pathogenesis of necrosing angiitis. This theory also allows a role to be attributed to certain infectious agents (viral, bacterial, parasitic) in the development of periarteritis nodosa (PAN). An infectious syndrome was found in all our 9 patients, aged 26 to 69 years, with histologically confirmed PAN: previous infection (over 15 days before hospital admission): otitis, hepatitis B, tonsillitis, ascaris (Case n.7), pulmonary tuberculosis, brucellosis, seropositivity for Chlamydia trachomatis (Case n.9), paratyphoid (Case n.5), seropositivity for Yersiniosis pseudo-tuberculosis (Case n.2), seropositivity for Chlamydia trachomatis (Cases 3 and 4), seropositivity for toxoplasmosis (Cases 4 and 6), seropositivity for rubella (Case n.8). Recent infection (less than 15 days before hospital admission): staphylococcus aureus septicaemia (Case n.1); Group A betahemolytic streptococcal urinary infection (Case n.2); Group A betahemolytic streptococcal otitis media; pseudomonas aeruginosa and Klebsiella septicaemia; enterococcal cystitis (Case n.4); progressive pulmonary tuberculosis (Case n.6), acinetobacter pneumonia (Case n.9). The HBs antigen was only found in one patient (Case n.6), who had an active hepatitis.
循环免疫复合物被认为在坏死性血管炎的发病机制中起重要作用。该理论也使某些感染因子（病毒、细菌、寄生虫）在结节性多动脉炎（PAN）的发病过程中具有了一定作用。我们所有9例年龄在26至69岁之间、经组织学确诊为PAN的患者均发现有感染综合征：既往感染（入院前超过15天）：中耳炎、乙型肝炎、扁桃体炎、蛔虫感染（病例7）、肺结核、布鲁氏菌病、沙眼衣原体血清阳性（病例9）、副伤寒（病例5）、假结核耶尔森菌血清阳性（病例2）、沙眼衣原体血清阳性（病例3和4）、弓形虫血清阳性（病例4和6）、风疹血清阳性（病例8）。近期感染（入院前少于15天）：金黄色葡萄球菌败血症（病例1）；A组β溶血性链球菌尿路感染（病例2）；A组β溶血性链球菌中耳炎；铜绿假单胞菌和克雷伯菌败血症；肠球菌膀胱炎（病例4）；进行性肺结核（病例6）、不动杆菌肺炎（病例9）。仅在1例患有活动性肝炎的患者（病例6）中发现了乙肝表面抗原。
