Holub M, Hobstová J, Prazák J, Pudil P
Infekcní klinika, Fakultní nemocnice na Bulovce, Praha.
Cas Lek Cesk. 1998 Oct 5;137(19):598-600.
The majority of meningococcal infections are characterized by nasopharyngeal carriership. In some patients invasive disease with a mild course develops, while some cases have a lethal outcome. The reasons of this wide variation range are not clear. The objective of the present work was to assess whether the development of invasive meningococcal disease or its prognosis are associated with HLA class I.
The group of patients was formed by 40 patients (29 females, 11 males, mean age 16 years, range 8 months to 52 years). In 28 patients the disease was caused by N. meningitidis group C, in 9 cases group B, in three cases the serotype was not assessed. The etiology was confirmed by cultivation or latex agglutination. Twenty-three patients had a mild course of the disease, 8 a medium severe one, 9 patients a severe clinical course (score according to Stiehme, Damrosch and Rosenblat). The patients were compared with 227 non-related blood donors (114 women, 113 men, 18 to 50 years old). In patients and controls 24 lymphocytic HLA antigens class I were identified as to type. Typing was done using the standard microlymphocytotoxic test in the NIH modification. The results were processed by statistical methods using Fisher's exact test and the 2 x 2 test with Yates correction. In patients with a mild course HLA antigens B7 and B12 predominate (p = 0.03; p = 0.02), in medium severe cases antigen A11 (p = 0.03), in patients with the most severe course antigen A9 (p = 0.04). In invasive infections caused by N. meningitidis serotype B antigen B17 predominates (p = 0.05).
The severity of meningococcal invasive infections is associated with HLA class I. Invasive disease caused by N. meningitidis serotype B are more likely to occur in carriers of HLA B17. No relationship was found between HLA class I and invasive disease caused by N. meningitidis regardless of serotype and with serotype C.
大多数脑膜炎球菌感染以鼻咽部带菌状态为特征。在一些患者中会发展为病程较轻的侵袭性疾病，而一些病例则会导致致命后果。这种广泛差异的原因尚不清楚。本研究的目的是评估侵袭性脑膜炎球菌病的发生或其预后是否与HLA - I类分子相关。
研究组由40例患者组成（29例女性，11例男性，平均年龄16岁，范围8个月至52岁）。28例患者的疾病由C群脑膜炎奈瑟菌引起，9例由B群引起，3例血清型未评估。病因通过培养或乳胶凝集法确诊。23例患者病程较轻，8例为中度严重，9例临床病程严重（根据施特希梅、达姆罗施和罗森布拉特评分）。将这些患者与227名无关献血者（114名女性，113名男性，年龄18至50岁）进行比较。对患者和对照组的24种淋巴细胞HLA - I类抗原进行分型鉴定。分型采用美国国立卫生研究院改良的标准微量淋巴细胞毒试验。结果采用费舍尔精确检验和校正Yates的2×2检验等统计方法进行处理。病程较轻的患者中HLA抗原B7和B12占主导（p = 0.03；p = 0.02），中度严重病例中抗原A11占主导（p = 0.03），病程最严重的患者中抗原A9占主导（p = 0.04）。在由B群脑膜炎奈瑟菌引起的侵袭性感染中，抗原B17占主导（p = 0.05）。
脑膜炎球菌侵袭性感染的严重程度与HLA - I类分子相关。HLA B17携带者更易发生由B群脑膜炎奈瑟菌引起的侵袭性疾病。未发现HLA - I类分子与无论何种血清型的脑膜炎奈瑟菌引起的侵袭性疾病以及C群引起的侵袭性疾病之间存在关联。
