Mustonen J, Partanen J, Kanerva M, Pietilä K, Vapalahti O, Pasternack A, Vaheri A
Medical School, University of Tampere, Tampere University Hospital, Finland.
Kidney Int. 1996 Jan;49(1):217-21. doi: 10.1038/ki.1996.29.
Nephropathia epidemica (NE) caused by Puumala hantavirus is one type of hemorrhagic fever with renal syndrome (HFRS). There is considerable variability in the clinical severity of NE. Many infections are subclinical but the disease can even be fatal. We questioned whether the wide spectrum in the outcome of NE is dependent, on host-related immunological factors by determining the major histocompatibility complex markers (MHC) in 74 adult patients with NE. Patients with the most severe course of the disease had a very high frequency of HLA B8, C4AQ0, and DRB10301 alleles. HLA B8 was found in all 7 (100%) patients with shock and in 9 of the 13 (69%) patients who required dialysis, versus in only 25 of 74 (34%) in the entire population, and in 14 of 93 (15%) controls. In addition, various other clinical findings pointing to a severe form of NE were found to be associated with these alleles. Interestingly, the same MHC alleles are risk factors for various autoimmune diseases. This is the first study where a certain HLA haplotype is found to be associated with the clinical course of an acute viral disease or acute nephritis.
由普马拉汉坦病毒引起的流行性肾病（NE）是肾综合征出血热（HFRS）的一种类型。NE的临床严重程度存在很大差异。许多感染是亚临床的，但该疾病甚至可能致命。我们通过测定74例成年NE患者的主要组织相容性复合体标志物（MHC），质疑NE预后的广泛差异是否取决于宿主相关的免疫因素。疾病病程最严重的患者中，HLA B8、C4AQ0和DRB10301等位基因的频率非常高。在所有7例（100%）休克患者以及13例需要透析的患者中的9例（69%）中发现了HLA B8，而在整个人群的74例中仅25例（34%）发现，在93例对照中有14例（15%）发现。此外，发现各种其他指向严重NE形式的临床发现与这些等位基因相关。有趣的是，相同的MHC等位基因是各种自身免疫性疾病的危险因素。这是首次发现某种HLA单倍型与急性病毒性疾病或急性肾炎的临床病程相关的研究。
