McCluskey R T
Am J Kidney Dis. 1982 Jul;2(1 Suppl 1):119-25.
Immunofluorescence findings have provided evidence for widespread immune complex deposits in SLE. Studies of severe proliferative lupus nephritis have shown that DNA-anti DNA complexes are of major importance. The immune complex systems in the deposits of mesangial and membranous lupus nephritis, as well as in extraglomerular sites have not been thoroughly analyzed, but there is evidence that antinuclear antibodies participate. The key role of DNA complexes in severe lupus nephritis (and probably in other lesions) may be due to its affinity for basement membranes. It is not clear to what extent immune complex deposits are initially formed in situ or as the result of arrest of circulating complexes; in any case, circulating complexes, which are present in high levels in patients with active SLE, are probably of crucial importance in SLE, since they can clearly form deposits in certain sites, add to existing deposits, saturate the reticuloendothelial system and exert other effects, such as on leucocyte function and the immune response. Other pathogenetic mechanisms are also of importance in SLE. In particular, autoantibodies against cell surface antigens can cause abnormalities of circulating cells and possibly parenchymal cells (as shown in studies on anti-brain antibodies). Experimental studies indicate that DTH reactions could account for some of the lesions of SLE, including glomerular lesions, but definitive evaluation of this mechanism awaits the development of techniques that allow positive identification of cell mediated reactions in vivo.
免疫荧光检查结果为系统性红斑狼疮（SLE）中广泛存在的免疫复合物沉积提供了证据。对重度增殖性狼疮性肾炎的研究表明，DNA-抗DNA复合物至关重要。系膜性和膜性狼疮性肾炎沉积物以及肾小球外部位的免疫复合物系统尚未得到充分分析，但有证据表明抗核抗体参与其中。DNA复合物在重度狼疮性肾炎（可能也在其他病变中）的关键作用可能归因于其对基底膜的亲和力。目前尚不清楚免疫复合物沉积物在多大程度上最初是原位形成的，还是循环复合物滞留的结果；无论如何，在活动性SLE患者中高水平存在的循环复合物在SLE中可能至关重要，因为它们显然可在某些部位形成沉积物，增加现有沉积物，使网状内皮系统饱和并发挥其他作用，如对白细胞功能和免疫反应的影响。其他发病机制在SLE中也很重要。特别是，针对细胞表面抗原的自身抗体可导致循环细胞以及可能的实质细胞异常（如抗脑抗体研究所示）。实验研究表明，迟发型超敏反应（DTH）可能是SLE某些病变的原因，包括肾小球病变，但对该机制的确切评估有待能够在体内阳性识别细胞介导反应的技术的发展。
