Read S E, Fischetti V A, Utermohlen V, Falk R E, Zabriskie J B
J Clin Invest. 1974 Aug;54(2):439-50. doi: 10.1172/JCI107780.
The question of whether hypersensitivity to streptococcal antigens plays a role in the pathogenesis of the nonsuppurative sequelae of streptococcal infections remains at present unclear. As a first step in the approach to this question, the degree of cellular reactivity of peripheral blood leucocytes to streptococcal antigens was investigated in a number of rheumatic fever patients, patients with uncomplicated streptococcal infections, as well as normal healthy subjects. Using the in vitro technique for the inhibition of capillary migration of peripheral blood leucocytes as an index of the degree of sensitivity to streptococcal antigens, the results indicate that patients with acute rheumatic fever exhibit an exaggerated cellular reactivity to these antigens and in particular to streptococcal cell membrane antigens. This abnormal response to streptococcal membrane antigens appears to persist in rheumatic subjects for at least 5 yr after the initial attack of rheumatic fever. Only Group A streptococcal membrane antigens elicited this unusual response in rheumatic subjects, since the cellular reactivity to Group C and D streptococcal membranes was the same in all groups. Patients with evidence of valvular disease exhibited the same degree of cellular reactivity to these antigens as did patients without clinical evidence of rheumatic heart disease. The nature of the antigens responsible for the observed cellular response remains unknown. Enzymatic treatment of streptococcal cell walls and membranes designed to remove type-specific M proteins did not alter the observed cellular reactivity to the streptococcal antigens. The finding that an abnormal cellular response to certain streptococcal antigens is present only in rheumatic patients suggests that cell-mediated factors may play an important role in the disease process.
目前尚不清楚对链球菌抗原的超敏反应是否在链球菌感染的非化脓性后遗症发病机制中起作用。作为探讨这个问题的第一步，我们对一些风湿热患者、单纯性链球菌感染患者以及正常健康受试者外周血白细胞对链球菌抗原的细胞反应程度进行了研究。以外周血白细胞毛细管迁移抑制的体外技术作为对链球菌抗原敏感程度的指标，结果表明，急性风湿热患者对这些抗原，尤其是对链球菌细胞膜抗原表现出过度的细胞反应。这种对链球菌膜抗原的异常反应在风湿热初次发作后至少5年的风湿患者中似乎持续存在。只有A组链球菌膜抗原在风湿患者中引发这种异常反应，因为所有组对C组和D组链球菌膜的细胞反应是相同的。有瓣膜病证据的患者对这些抗原的细胞反应程度与无风湿性心脏病临床证据的患者相同。引起所观察到的细胞反应的抗原性质尚不清楚。旨在去除型特异性M蛋白的链球菌细胞壁和细胞膜的酶处理并未改变所观察到的对链球菌抗原的细胞反应。仅在风湿患者中存在对某些链球菌抗原的异常细胞反应这一发现表明，细胞介导因子可能在疾病过程中起重要作用。
