Laureti S, De Bellis A, Muccitelli V I, Calcinaro F, Bizzarro A, Rossi R, Bellastella A, Santeusanio F, Falorni A
Department of Internal Medicine and Endocrine and Metabolic Sciences, University of Perugia, Italy.
J Clin Endocrinol Metab. 1998 Oct;83(10):3507-11. doi: 10.1210/jcem.83.10.5149.
To test the hypothesis that levels of adrenal autoantibodies correlate with the degree of adrenal dysfunction, we followed up adrenal cortex autoantibody (ACA) titers and 21-hydroxylase (21OH) autoantibody (21OHAb) levels in 19 ACA-positive subjects with preclinical Addison's disease. On enrollment, all the 19 ACA-positive subjects were positive for 21OHAb. At follow-up, the concordance rate for simultaneous presence/absence of both ACA and 21OHAb was as high as 91% and a strong, positive correlation between 21OHAb levels and ACA titers was observed (P < 0.0001). The levels of adrenal autoantibodies were positively associated with the severity of adrenal dysfunction (ANOVA, P < 0.0001 for both 21OHAb and ACA): the 21OH index was significantly lower at stage 0 or 1 than at stage 2+3 (corrected P < 0.001 andP < 0.05) or stage 4 (corrected P < 0.001 and <0.01). Similarly, ACA titer at stage 4 was significantly higher than stage 0 (P < 0.001), stage 1 (P < 0.001), and stage 2+3 (P < 0.05); and ACA titer at stage 2+3 was higher than stage 0 (P < 0.001) and stage 1 (P < 0.05). In subjects with progression of adrenal dysfunction (n = 14), levels of 21OHAb and ACA increased significantly (P = 0.041 and P = 0.002) during the follow-up period. In 5 subjects, the remission of biochemical signs of adrenal dysfunction was associated with the disappearance of both ACA and 21OHAb. Our study shows that the levels of adrenal autoantibodies correlate with the degree of adrenal dysfunction, and this suggests that production of high-level 21OHAb strongly signals the destructive phase of the autoimmune disease process.
为了验证肾上腺自身抗体水平与肾上腺功能障碍程度相关的假设，我们对19例临床前期艾迪生病的肾上腺皮质自身抗体（ACA）滴度和21-羟化酶（21OH）自身抗体（21OHAb）水平进行了随访。入组时，所有19例ACA阳性受试者的21OHAb均为阳性。随访时，ACA和21OHAb同时存在/不存在的一致率高达91%，并且观察到21OHAb水平与ACA滴度之间存在强正相关（P < 0.0001）。肾上腺自身抗体水平与肾上腺功能障碍的严重程度呈正相关（方差分析，21OHAb和ACA的P均 < 0.0001）：21OH指数在0期或1期显著低于2 + 3期（校正P < 0.001和P < 0.05）或4期（校正P < 0.001和<0.01）。同样，4期的ACA滴度显著高于0期（P < 0.001）、1期（P < 0.001）和2 + 3期（P < 0.05）；2 + 3期的ACA滴度高于0期（P < 0.001）和1期（P < 0.05）。在肾上腺功能障碍进展的受试者（n = 14）中，随访期间21OHAb和ACA水平显著升高（P = 0.041和P = 0.002）。在5例受试者中，肾上腺功能障碍生化指标的缓解与ACA和21OHAb的消失相关。我们的研究表明，肾上腺自身抗体水平与肾上腺功能障碍程度相关，这表明高水平21OHAb的产生强烈预示着自身免疫疾病过程的破坏阶段。
