Dudding B A, Ayoub E M
J Exp Med. 1968 Nov 1;128(5):1081-98. doi: 10.1084/jem.128.5.1081.
Antibody levels to streptococcal Group A and A-variant carbohydrates were determined using a radioactive immune precipitation technique on patients with rheumatic fever, with and without valvular disease, on patients with post-streptococcal acute glomerulonephritis, and on age-matched controls. During the acute phase of the above illness, the means of the antibody levels to both carbohydrate antigens were equally elevated and were significantly higher than the normal controls. When Group A antibody levels were determined on sera obtained at intervals of 5-12 months and 1-5 yr after the acute illness) it was found that the antibody levels declined within the normal range at the 5-12 month interval in patients with glomerulonephritis as well as in patients with rheumatic fever in whom no valvular involvement had complicated the disease, i.e., patients with pure Sydenham's chorea. However, in patients with rheumatic valvulitis, who had been on penicillin prophylaxis after the last acute episode, the A antibody level showed little decline from the level obtained during the acute illness. The elevated antibody level in patients with rheumatic valvulitis, including patients with Sydenham's chorea with valvulitis, persisted for periods of at least 1 yr and up to 20 yr after the last acute attack. The pattern of the decline of the antibody levels to the A-variant carbohydrate as well as of the antibody titers to the other streptococcal antigens tested, ASO and anti-DNase B, was similar in all patients studied regardless of the presence of valvular disease. These findings suggest that prolonged persistence of the Group A antibody is a phenomenon peculiar to patients with rheumatic valvular disease. Whether this persistence is involved in the pathogenesis or is an outcome of the valvular disease remains to be determined.
采用放射性免疫沉淀技术，对患有风湿热（有或无瓣膜病）、链球菌感染后急性肾小球肾炎的患者以及年龄匹配的对照组，测定其抗A组链球菌及A变异株碳水化合物的抗体水平。在上述疾病的急性期，两种碳水化合物抗原的抗体水平均值均同等升高，且显著高于正常对照组。在急性病后间隔5 - 12个月及1 - 5年采集的血清中测定A组抗体水平时，发现肾小球肾炎患者以及未并发瓣膜受累的风湿热患者（即单纯 Sydenham舞蹈病患者），在5 - 12个月时抗体水平降至正常范围。然而，在最后一次急性发作后接受青霉素预防治疗的风湿性心瓣膜炎患者中，A抗体水平与急性期相比几乎没有下降。包括患有瓣膜病的Sydenham舞蹈病患者在内的风湿性心瓣膜炎患者，其抗体水平升高在最后一次急性发作后持续至少1年，最长可达20年。在所有研究患者中，无论是否存在瓣膜病，抗A变异株碳水化合物抗体水平以及针对其他检测的链球菌抗原（抗链球菌溶血素O和抗脱氧核糖核酸酶B）的抗体滴度下降模式均相似。这些发现表明，A组抗体的长期持续存在是风湿性瓣膜病患者特有的现象。这种持续存在是参与了发病机制还是瓣膜病的结果，仍有待确定。
