Mackel S E, Tappeiner G, Brumfield H, Jordan R E
J Clin Invest. 1979 Dec;64(6):1652-60. doi: 10.1172/JCI109627.
To investigate the pathogeneic significance of immune complexes in cutaneous vasculitis, 107 patients with various forms of cutaneous vasculitis, including 59 patients with necrotizing (leukocytoclastic) vasculitis (group 1), and 48 patients with lymphocytic vasculitis, or a predominately lymphocytic perivascular infiltrate (group 2), were studied. Immunoglobulins or complement components in cutaneous blood vessels were detected by direct immunofluorescence in high frequency in both groups (91 and 88%, respectively). Using two radioassays for circulating immune complexes, Clq or monoclonal rheumatoid factor (mRF) reactive material was detected in 68% of the patients with necrotizing vasculitis but only 44% of the patients in the lymphocytic-perivascular group. The mRF radioassay was elevated in 58% of the first group of patients and 41% of the patients in group 2, although Clq binding activity was increased in 54% of the patients with necrotizing vasculitis but only in 9% of the patients with a lymphocytic vasculitis or lymphocytic perivascular infiltrate. By using both sucrose density gradient ultracentrifugation and Sepharose 6B gel filtration, the Clq and mRF reactive material detected in some patients with necrotizing vasculitis eluted in high molecular weight fractions that were also anticomplementary. In one patient with necrotizing vasculitis and hepatitis B antigenemia, these heavy molecular weight Clq and mRF reactive fractions contained a two- to three-fold increase in hepatitis B surface antigen when compared with lighter molecular weight fractions. Heavy and light molecular weight mRF reactive material could be detected in selected patients in the lymphocytic-perivascular group as well as in the necrotizing vasculitis group. These studies suggest that cutaneous vasculitis, including acute necrotizing (leukocytoclastic) vasculitis and some forms of lymphocytic vasculitis, and perhaps some diseases characterized by a lymphocytic perivascular infiltrate, may represent cutaneous expressions of immune complex disease.
为研究免疫复合物在皮肤血管炎中的致病意义，对107例各种类型的皮肤血管炎患者进行了研究，其中包括59例坏死性（白细胞破碎性）血管炎患者（第1组）和48例淋巴细胞性血管炎或主要为淋巴细胞性血管周围浸润患者（第2组）。通过直接免疫荧光法在两组中均高频检测到皮肤血管中的免疫球蛋白或补体成分（分别为91%和88%）。使用两种检测循环免疫复合物的放射测定法，在68%的坏死性血管炎患者中检测到Clq或单克隆类风湿因子（mRF）反应性物质，但在淋巴细胞性血管周围组患者中仅检测到44%。第1组58%的患者和第2组41%的患者mRF放射测定值升高，尽管54%的坏死性血管炎患者Clq结合活性增加，但淋巴细胞性血管炎或淋巴细胞性血管周围浸润患者中只有9%增加。通过使用蔗糖密度梯度超速离心和琼脂糖6B凝胶过滤法，在一些坏死性血管炎患者中检测到的Clq和mRF反应性物质在高分子量组分中洗脱，这些组分也具有抗补体作用。在1例坏死性血管炎合并乙肝抗原血症患者中，与低分子量组分相比，这些高分子量Clq和mRF反应性组分中的乙肝表面抗原增加了2至3倍。在淋巴细胞性血管周围组以及坏死性血管炎组的部分患者中可检测到高分子量和低分子量mRF反应性物质。这些研究表明，皮肤血管炎，包括急性坏死性（白细胞破碎性）血管炎和某些形式的淋巴细胞性血管炎，或许还有一些以淋巴细胞性血管周围浸润为特征的疾病，可能代表免疫复合物疾病的皮肤表现。
