Burgio G R, Cuccia M C, De Amici M
Clinica Pediatrica, Università di Pavia, Italia.
Pediatr Med Chir. 1996 Nov-Dec;18(6):537-43.
The identification of the causes of important infectious and hereditary diseases became scientifically clear in the last years of the nineteenth century and in the first years of the twentieth. Through many centuries, the lack of etiologic knowledge regarding diseases has extraordinarily enhanced the value of the concept of predisposition so that "diathesis" helped to "explain" many forms of morbidity. Several discoveries as to the real "causes" of diseases, however, led to a critical downgrading of its value. But in-depth knowledge regarding the proteins controlled by genes of the "major histocompatibility complex" (MHC, HLA) in man was followed, a few years later, by the demonstration of the fact that carriers of particular alleles are exposed to higher risks of contracting certain diseases than non-carriers of these molecules. A new key for interpretation-this time, a genetic and molecular one-was thus offered for the concept of "predisposition". Actually, man's HLA-associated molecular individuality induces and causes an extraordinarily personal way of reacting to various stimuli. An obvious consequence of this is not only that man, having become aware of his "molecular uniqueness" (which is significantly HLA-related), can view himself as a "biological Ego" but, most of all, that some of his predispositions towards becoming ill may be ascribed to some of his individual molecular characterizations. Thus, the onset and the course of many diseases would be viewed as the effect of a given "way of reacting". This could be recognized as the true essence of diathesis, 18 centuries after Galen.
重要传染病和遗传病病因的确定在19世纪最后几年和20世纪头几年才在科学上变得清晰起来。几个世纪以来，对疾病病因学知识的缺乏极大地提升了易感性概念的价值，以至于“素质”有助于“解释”多种发病形式。然而，关于疾病真正“病因”的几项发现导致了其价值的批判性降低。但是，在深入了解人类“主要组织相容性复合体”（MHC，HLA）基因所控制的蛋白质之后，几年后又证明了这样一个事实：特定等位基因的携带者比这些分子的非携带者更容易感染某些疾病。因此，为“易感性”概念提供了一把新的解释钥匙——这次是遗传和分子层面的。实际上，人类与HLA相关的分子个体性会引发并导致对各种刺激的一种极其个性化的反应方式。由此产生的一个明显后果不仅是，人类在意识到自己的“分子独特性”（这与HLA密切相关）后，可以将自己视为一个“生物学自我”，而且更重要的是，他的一些患病易感性可能归因于他的一些个体分子特征。因此，许多疾病的发生和病程将被视为一种特定“反应方式”的结果。这可以被认为是素质的真正本质，这是在盖伦之后18个世纪得出的结论。
