Kotby A A, El Badawy N, El Sokkary S, Moawad H, El Shawarby M
Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Clin Diagn Lab Immunol. 1998 Nov;5(6):836-9. doi: 10.1128/CDLI.5.6.836-839.1998.
The objectives of our study were to examine the sera of rheumatic chorea (RhCh) patients (those with acute or chronic RhCh or with a past history of RhCh) for the presence of antineuronal antibodies (ANeurA) and to correlate the results with disease activity, chronicity, and the number and durations of choreic attacks. Subjects were inpatients of the Pediatric Hospital, Ain Shams University, and outpatients of the Outpatient Pediatric Cardiology Clinic (both in Cairo, Egypt). Forty children with RhCh (mean age, 10.9 years) and 40 healthy controls were tested. An indirect-immunofluorescence technique was used for the detection of ANeurA. ANeurA were present in the sera of 100, 93, and 44% of the patients with acute, chronic, and past histories of RhCh, respectively. A definition of chronic chorea is presented for the first time. None of the control subjects had ANeurA in their sera. The presence of ANeurA correlated with disease activity. A statistically significant increase (P < 0.01) in the prevalence of ANeurA was found for patients with active chorea (acute and chronic) compared with the prevalence in patients with past histories of RhCh (controlled chorea). ANeurA were present in the sera of both patients with acute RhCh and patients with chronic RhCh, yet patients with acute RhCh showed more brightness and cell staining than chronic patients. The severity, number, and duration of each attack were not related to the presence of ANeurA. These results strengthen further the concept of autoimmunity being the basis for the pathogenesis of RhCh. The presence of ANeurA correlated with the activity of RhCh but not with the severity, number, or duration of attacks. Humoral immunity definitely plays a role in RhCh; thus, routine administration of corticosteroids to patients with acute RhCh is suggested to prevent neuron damage and chronicity. The chronicity of chorea is not due to a further increase in ANeurA but is probably due to sensitivity to these antibodies.
我们研究的目的是检测风湿性舞蹈病（RhCh）患者（急性或慢性RhCh患者或有RhCh既往病史者）血清中抗神经元抗体（ANeurA）的存在情况，并将结果与疾病活动度、慢性病程以及舞蹈症发作的次数和持续时间相关联。研究对象为艾因夏姆斯大学儿科医院的住院患者以及儿科心脏病门诊（均位于埃及开罗）的门诊患者。对40例RhCh患儿（平均年龄10.9岁）和40例健康对照者进行了检测。采用间接免疫荧光技术检测ANeurA。急性、慢性和有RhCh既往病史的患者血清中ANeurA阳性率分别为100%、93%和44%。首次给出了慢性舞蹈症的定义。对照者血清中均未检测到ANeurA。ANeurA的存在与疾病活动度相关。与有RhCh既往病史（静止性舞蹈症）的患者相比，活动期舞蹈症（急性和慢性）患者中ANeurA的阳性率有统计学意义的显著升高（P < 0.01）。急性RhCh患者和慢性RhCh患者血清中均存在ANeurA，但急性RhCh患者的荧光亮度和细胞染色比慢性患者更明显。每次发作的严重程度、次数和持续时间与ANeurA的存在无关。这些结果进一步强化了自身免疫是RhCh发病机制基础的概念。ANeurA的存在与RhCh的活动度相关，但与发作的严重程度、次数或持续时间无关。体液免疫在RhCh中肯定起作用；因此，建议对急性RhCh患者常规使用皮质类固醇以预防神经元损伤和慢性病程。舞蹈症的慢性病程并非由于ANeurA进一步增加，可能是由于对这些抗体敏感所致。
