Hall R P, Eyre R W
J Invest Dermatol. 1987 Jul;89(1):27-31. doi: 10.1111/1523-1747.ep12580310.
Thirty to forty percent of patients with dermatitis herpetiformis (DH) have IgA-containing circulating immune complexes (IgA-CIC); however, the antigenic composition of these complexes as well as the role they play in the pathogenesis of DH are unknown. The failure to detect wheat protein in these IgA-CIC, despite the association of DH with gluten-sensitive enteropathy, suggests that the IgA-CIC in DH may be similar to those seen in the IgA nephropathies and represent IgA rheumatoid factor (RF)-IgG complexes. We have examined the sera of 32 patients with DH, 16 non-DH patients positive for RF by latex fixation, and 15 normal subjects for IgA and IgM RF using enzyme-linked immunosorbent assays (ELISAs) and for IgA-CIC using an anti-C3 ELISA. Thirteen of 16 (81%) latex fixation test-positive patients had IgA RF by ELISA and 15/16 (94%) had IgM RF by ELISA. The total amount of RF detected by the ELISA (IgA + IgM RF) correlated with the latex fixation titer (r = 0.678, p = 0.004) in these latex fixation-positive patients. Six of the 16 (38%) latex fixation-positive patients also were found to have IgA-CIC. Solid phase absorption using goat antihuman C3 decreased the levels of immune complexes but not the level of IgA RF, suggesting the IgA-CIC detected do not represent uncomplexed IgA RF. In contrast, although 12 of 31 (39%) patients with DH had IgA-CIC ranging in amount from 0.331-26.0 micrograms IgA/ml (nl less than 0.150 microgram IgA/ml), only 1 of 32 (3%) DH patients had detectable levels of IgA RF (7.0 micrograms IgA/ml, nl less than 2.0 micrograms IgA/ml). Low levels of IgM RF were found in 8/32 (25%) of patients with DH (1.1-1.6 micrograms IgM/ml, nl less than 1.0 microgram IgM/ml). These data document that IgA RF is not present in the sera of patients with DH independent of the presence or absence of IgA-CIC and that it is unlikely that the IgA-CIC present are IgA RF complexed with autologous IgG.
30%至40%的疱疹样皮炎（DH）患者有含IgA的循环免疫复合物（IgA-CIC）；然而，这些复合物的抗原组成以及它们在DH发病机制中所起的作用尚不清楚。尽管DH与麸质敏感性肠病有关，但在这些IgA-CIC中未能检测到小麦蛋白，这表明DH中的IgA-CIC可能与IgA肾病中所见的类似，代表IgA类风湿因子（RF）-IgG复合物。我们使用酶联免疫吸附测定（ELISA）检测了32例DH患者、16例乳胶凝集试验检测RF阳性的非DH患者以及15名正常受试者的血清中的IgA和IgM RF，并使用抗C3 ELISA检测IgA-CIC。16例乳胶凝集试验阳性患者中有13例（81%）ELISA检测有IgA RF，15/16例（94%）有IgM RF。在这些乳胶凝集试验阳性患者中，ELISA检测到的RF总量（IgA + IgM RF）与乳胶凝集滴度相关（r = 0.678，p = 0.004）。16例乳胶凝集试验阳性患者中有6例（38%）也被发现有IgA-CIC。使用山羊抗人C3进行固相吸收可降低免疫复合物水平，但不降低IgA RF水平，这表明检测到的IgA-CIC并不代表未复合的IgA RF。相比之下，虽然31例DH患者中有12例（39%）的IgA-CIC含量在0.331 - 26.0微克IgA/ml之间（正常范围小于0.150微克IgA/ml），但在32例DH患者中只有1例（3%）可检测到IgA RF水平（7.0微克IgA/ml，正常范围小于2.0微克IgA/ml）。在8/32例（25%）DH患者中发现低水平的IgM RF（1.1 - 1.6微克IgM/ml，正常范围小于1.0微克IgM/ml）。这些数据表明，无论是否存在IgA-CIC，DH患者血清中均不存在IgA RF，而且目前存在的IgA-CIC不太可能是与自身IgG复合的IgA RF。
