Compston D A, Vakarelis B N, Paul E, McDonald W I, Batchelor J R, Mims C A
Brain. 1986 Apr;109 ( Pt 2)(2):325-44. doi: 10.1093/brain/109.2.325.
Retrospective comparisons of the prevalence and age, where appropriate, of some childhood infectious illnesses and vaccinations, together with serological evidence for exposure to 16 viruses, many of which have previously been implicated in the aetiology of multiple sclerosis (MS) were made in 177 patients with acute optic neuritis, other recent isolated demyelinating episodes or established MS and 164 controls. The expected high frequency of HLA-DR2 in patients with demyelinating disease was matched by preselection of normal controls with this antigen (DR2+); the remaining individuals were classified as HLA-DR2 negative/DR3 positive (DR3+) or HLA-DR2 and 3 negative (DR2/3 -). Cases were compared with controls, collectively and in analyses restricted to each genetic group; these comparisons were repeated considering the three categories of patients with demyelination and two control populations separately. All DR2+, DR3+ and DR2/3 - individuals were compared in a single analysis to assess the effect of HLA type itself on the results. Patients with demyelinating disease had rubella and measles at a later age and reported mumps infection more frequently than controls. Age of typhoid vaccination and duration of exposure to domestic dogs was higher in all cases than controls. Age of measles and mumps, but not rubella, was higher in DR2+ cases than controls; but differences were not observed in the other genetic groups. Higher rubella antibody titres were present in all cases than controls and in analyses confined to DR2+ individuals in whom higher Epstein Barr virus antibody titres were also present. Measles haemagglutination inhibition and parainfluenza I antibody titres were increased and influenza A antibodies detected less frequently in all patients with optic neuritis and those with DR2 compared with appropriate controls; influenza B antibody titres were lower in all DR2+ cases than controls. Higher adenovirus and varicella zoster antibody titres were present in DR2/3- patients with demyelination and other neurological diseases compared with normal controls. Overall, older age of infection and higher antibody titres were observed more often in patients with optic neuritis, in particular DR2+ cases, than other individuals with demyelination or controls. Our serological results are consistent with the presence of abnormal HLA-immunological reactivity in patients with MS but cannot be explained only by an effect of DR type itself; age at which susceptible individuals develop some common childhood infections may also influence the subsequent development of the disease.
对177例急性视神经炎患者、近期其他孤立性脱髓鞘发作患者或确诊为多发性硬化症（MS）的患者以及164名对照者，就某些儿童期传染病和疫苗接种的患病率及年龄（如适用）进行了回顾性比较，并对16种病毒的暴露血清学证据进行了比较，其中许多病毒此前被认为与MS的病因有关。通过预先选择具有该抗原（DR2+）的正常对照者，使脱髓鞘疾病患者中预期的高频率HLA-DR2得以匹配；其余个体被分类为HLA-DR2阴性/DR3阳性（DR3+）或HLA-DR2和3阴性（DR2/3 -）。将病例与对照者进行总体比较，并在仅限于每个基因组的分析中进行比较；考虑到脱髓鞘的三类患者和两个对照人群，分别重复这些比较。在单一分析中对所有DR2+、DR3+和DR2/3 -个体进行比较，以评估HLA类型本身对结果的影响。脱髓鞘疾病患者患风疹和麻疹的年龄较晚，且报告患腮腺炎感染的频率高于对照者。所有病例中伤寒疫苗接种的年龄和接触家犬的时长均高于对照者。DR2+病例中麻疹和腮腺炎（而非风疹）的发病年龄高于对照者；但在其他基因组中未观察到差异。所有病例中的风疹抗体滴度均高于对照者，在仅限于DR2+个体的分析中，其爱泼斯坦-巴尔病毒抗体滴度也较高。与适当对照者相比，所有视神经炎患者及DR2患者中的麻疹血凝抑制和副流感I抗体滴度升高，甲型流感抗体检测频率较低；所有DR2+病例中的乙型流感抗体滴度均低于对照者。与正常对照者相比，DR2/3 -脱髓鞘及其他神经疾病患者中的腺病毒和水痘带状疱疹抗体滴度较高。总体而言，与其他脱髓鞘个体或对照者相比，视神经炎患者（尤其是DR2+病例）中感染年龄较大和抗体滴度较高的情况更为常见。我们的血清学结果与MS患者中存在异常的HLA免疫反应性一致，但不能仅用DR类型本身的作用来解释；易感个体发生某些常见儿童期感染的年龄也可能影响该疾病的后续发展。
