Maisch B, Trostel-Soeder R, Stechemesser E, Berg P A, Kochsiek K
Clin Exp Immunol. 1982 Jun;48(3):533-45.
Sera of 177 patients with acute myocarditis (10 coxsackie B 3/4, four influenza, four mumps, 15 cytomegalovirus, 144 undefined) were tested by indirect immunofluorescence for autoantibodies against heart and skeletal muscle and vital or air-dried adult cardiocytes. Antibody-dependent cytolysis, lymphocytotoxicity and antibody-dependent cellular lymphocytotoxicity were assessed using viral adult rat cardiocytes as target cells. Muscle-specific anti-sarcolemmal antibodies of the anti-myolemmal type--often associated with non-organ-specific anti-endothelial antibodies--were demonstrated in nine out of 10 patients with coxsackie B, in all patients with influenza and mumps and in 65 out of 144 patients with undefined myocarditis. In contrast, 13 out of 15 patients with cytomegalovirus myocarditis lacked anti-sarcolemmal antibodies but had low titre anti-inter fibrillary antibodies instead. In the presence of complement, anti-myolemmal antibodies induced cytolysis of vital cardiocytes, whereas hepatocytes remained unaffected. Titres of anti-myolemmal antibodies correlated with the degree of cardiocytolysis. The anti-myolemmal immunofluorescent pattern and the cytolytic serum activity could be absorbed with the respective viral antigens suggesting that these antibodies cross-react with moieties of the virus itself and may be both diagnostic and aetiological markers in acute viral myocarditis. Lymphocyte-mediated cytotoxicity against heterologous cardiac target cells could not be observed in our patients with myocarditis of proven viral aetiology. However, lymphocyte-mediated cytotoxicity was demonstrated in 10 ASA-positive and one ASA-negative patient with myocarditis of unknown origin. ASA-positive sera blocked lymphocytotoxicity in three of these patients.
对177例急性心肌炎患者（10例柯萨奇B 3/4型、4例流感、4例腮腺炎、15例巨细胞病毒感染、144例病因不明）的血清进行间接免疫荧光检测，以检测针对心脏和骨骼肌以及活体或风干成人心肌细胞的自身抗体。使用成年大鼠病毒性心肌细胞作为靶细胞，评估抗体依赖性细胞溶解、淋巴细胞毒性和抗体依赖性细胞淋巴细胞毒性。抗肌膜型的肌肉特异性抗肌膜抗体（通常与非器官特异性抗内皮抗体相关）在10例柯萨奇B患者中的9例、所有流感和腮腺炎患者以及144例病因不明的心肌炎患者中的65例中得到证实。相比之下，15例巨细胞病毒性心肌炎患者中有13例缺乏抗肌膜抗体，但有低滴度的抗肌原纤维间抗体。在补体存在的情况下，抗肌膜抗体诱导活体心肌细胞溶解，而肝细胞未受影响。抗肌膜抗体的滴度与心肌细胞溶解程度相关。抗肌膜免疫荧光模式和溶细胞血清活性可被相应的病毒抗原吸收，这表明这些抗体与病毒本身的部分发生交叉反应，可能是急性病毒性心肌炎的诊断和病因学标志物。在我们病因已证实为病毒感染的心肌炎患者中，未观察到淋巴细胞介导的针对异源性心脏靶细胞的细胞毒性。然而，在10例抗平滑肌抗体（ASA）阳性和1例ASA阴性的病因不明的心肌炎患者中，证实存在淋巴细胞介导的细胞毒性。在其中3例患者中，ASA阳性血清可阻断淋巴细胞毒性。
