Zilliox A P, Domoto D T, Hutcheson P S, Tsai C C, Slavin R G
Department of Internal Medicine, St. Louis University Medical Center, Missouri 63104-1028.
J Clin Immunol. 1993 Nov;13(6):415-23. doi: 10.1007/BF00920017.
The syndrome of Henoch-Schoenlein purpura developed in a 74-year-old woman after receiving streptokinase as thrombolytic therapy for an acute myocardial infarction. Renal biopsy revealed mesangial hypercellularity with deposits of IgA. Skin biopsy also revealed IgA deposition. Immunological studies showed evidence of sensitization to streptokinase. Elevated IgG, IgA, IgM, and IgE antistreptokinase antibodies were detected in the acute serum. Positive immediate skin reactivity to streptokinase was also present. Serum precipitins to streptokinase disappeared when IgA was removed from the serum. Positive staining with biotinylated streptokinase was seen in the skin in the same pattern of distribution as IgA. These findings strongly support the role of streptokinase and IgA in the pathogenesis of Henoch-Schoenlein purpura in this patient. A control group of streptococcal-infected patients showed no immune response to streptokinase. Another control group of streptokinase-treated patients, who had no untoward reaction, had elevated immunoglobulin classes and precipitins to streptokinase. However, the precipitating antibody was IgG and streptokinase skin tests were negative.
一名74岁女性在接受链激酶溶栓治疗急性心肌梗死后发生了过敏性紫癜综合征。肾活检显示系膜细胞增多伴IgA沉积。皮肤活检也显示有IgA沉积。免疫学研究显示对链激酶致敏的证据。在急性期血清中检测到IgG、IgA、IgM和IgE抗链激酶抗体升高。对链激酶的即刻皮肤反应也呈阳性。当从血清中去除IgA时，血清中链激酶沉淀素消失。用生物素化链激酶进行的阳性染色在皮肤中呈现出与IgA相同的分布模式。这些发现有力地支持了链激酶和IgA在该患者过敏性紫癜发病机制中的作用。一组链球菌感染患者对链激酶无免疫反应。另一组接受链激酶治疗且无不良反应的患者免疫球蛋白类别升高，对链激酶有沉淀素。然而，沉淀抗体为IgG，链激酶皮肤试验为阴性。
