Careless D J, Chiu B, Rabinovitch T, Wade J, Inman R D
University of Toronto, Canada.
J Rheumatol. 1997 Jan;24(1):102-8.
To characterize the rheumatic diseases associated with acute anterior uveitis and examine the potential role of Yersinia enterocolitica in the pathogenesis of acute anterior uveitis.
44 patients with acute anterior uveitis were assessed for evidence of an underlying rheumatic syndrome by history and examination. HLA profiles were identified by serologic and molecular techniques. Serological analysis of patients' sera for the presence of antibodies to Y. enterocolitica was by Western blot.
30 of the 44 patients had musculoskeletal symptoms. Of these, 8 had ankylosing spondylitis, 4 reactive arthritis, 2 undifferentiated spondyloarthropathy (SpA), 2 inflammatory bowel disease, one seronegative polyarthritis, and 13 mechanical back pain. Of 42 patients typed, 29 (69%) were HLA B27 positive and an additional 7 patients expressed a crossreactive group antigen (86% of total group B27 or CREG positive). Western blot analysis of the sera revealed increased frequency of antibodies to Yersinia compared with a control population. Antibodies directed against the 36 and 27 kDa Yersinia antigens were recognized with greater frequency (p < 0.05) in patients with acute anterior uveitis than in controls. IgG reactivity was more pronounced than IgA reactivity. Adsorption studies showed significant cross reactivity of anti-Yersinia antibodies with Salmonella typhimurium. Among the patients with acute anterior uveitis anti-Yersinia reactivity did not correlate with the HLA profile, nor with the presence of an underlying rheumatic disease.
SpA represent the commonest underlying rheumatic disorders associated with acute anterior uveitis. The majority of patients with acute anterior uveitis possess HLA-B27 regardless of whether there is underlying SpA. Patients with acute anterior uveitis show increased frequency of anti-Yersinia antibodies compared with controls. Many of these antibodies appear to be directed against antigenic determinants shared among gram negative bacteria and thus cannot constitute definitive evidence for a causal role specifically for Yersinia in acute anterior uveitis. Acute anterior uveitis represents an interplay of host susceptibility and microbial triggers, as is the case for the SpA in general.
明确与急性前葡萄膜炎相关的风湿性疾病，并探讨小肠结肠炎耶尔森菌在急性前葡萄膜炎发病机制中的潜在作用。
通过病史和检查评估44例急性前葡萄膜炎患者是否存在潜在风湿综合征的证据。采用血清学和分子技术鉴定HLA谱。通过蛋白质印迹法对患者血清进行小肠结肠炎耶尔森菌抗体检测。
44例患者中有30例有肌肉骨骼症状。其中，8例为强直性脊柱炎，4例为反应性关节炎，2例为未分化脊柱关节病（SpA），2例为炎症性肠病，1例为血清阴性多关节炎，13例为机械性背痛。在42例分型患者中，29例（69%）HLA B27阳性，另外7例表达交叉反应性组抗原（占B27或CREG阳性总数的86%）。血清蛋白质印迹分析显示，与对照组相比，急性前葡萄膜炎患者中抗耶尔森菌抗体的频率增加。与对照组相比，急性前葡萄膜炎患者中针对36 kDa和27 kDa耶尔森菌抗原的抗体识别频率更高（p < 0.05）。IgG反应性比IgA反应性更明显。吸附研究显示抗耶尔森菌抗体与鼠伤寒沙门菌有显著交叉反应。在急性前葡萄膜炎患者中，抗耶尔森菌反应性与HLA谱无关，也与潜在风湿性疾病的存在无关。
SpA是与急性前葡萄膜炎相关的最常见潜在风湿性疾病。无论是否存在潜在的SpA，大多数急性前葡萄膜炎患者都具有HLA-B27。与对照组相比，急性前葡萄膜炎患者中抗耶尔森菌抗体的频率增加。这些抗体中的许多似乎针对革兰氏阴性菌共有的抗原决定簇，因此不能构成小肠结肠炎耶尔森菌在急性前葡萄膜炎中具有因果作用的确切证据。急性前葡萄膜炎代表了宿主易感性和微生物触发因素的相互作用，这与一般的SpA情况相同。
