摘要
类风湿关节炎(简称类风湿,RA)是一自身免疫疾病,最重要的病理改变是滑膜炎,但也可侵及浆膜、心、肺及眼等器官。本文采用免疫组织化学方法对RA及其它风湿性疾病的滑膜进行了检测,探讨了此项检查在RA诊断中的意义。材料与方法一、病例的选择 46例各种关节病患者滑膜标本取自北京协和医院内科及北京建筑工人医院骨科,均为住院并施行关节镜手术的病人,术后诊断为:RA21例,男7例、女14例,年龄 17～63岁。病程最短者1年,最长者18年,平均6.5年左右;血清阴性脊柱关节病4例,反应性关节炎4例;
46 patients with different rheumatic disorders were subjected to arthroscopic examination and the biopsied synovia were studied immunopathologically. Immunoglobulins, complements and fibrinogen deposition were delected by direct immunofluorescence, and rheumatoid factor (RF) deposition was detected by peroxidase-labelled denatured human IgG. Postoperative diagnosis of these cases were as follows: rheumatoid arthritis (RA) 21; seronegative spondyarthropathy 4; reactive arthritis 2; undentifined synovitis 4; oseoarthritis 8; and non- synovitis conditions 5. It was shown that the positive rates of deposition of IgG, IgM, complement C3, C1q and C4, and RF in RA were 95.2%, 52.4%. 38.1%, 28.6%, 9.5% and 42.9%, respectively. Deposition was negative in all other rheumatic dis- eases. The positive fibrinogen deposition rate in RA was 42.9%; it was weakly positive in other disorders as well. The results indicate that the pathogenesis of RA is related to humoral immunity, and immunopathological study of the synovium has very important diagnostic significance in RA. On the other hand, deposition of fibrinogen lacks specificity for any rheumatic disease. The deposition of RF IgG, IgM and complement C3, C1q and C4 in the synovium of RA patients does not correlate well with clinical disease activity. The deposition of RF in the synovium also does not show paired correlation with blood IgM RF determination. This difference may be explained by the fact that the synovial RF examined in the present study may include all iso- types of RF and that hidden-RF in the blood may give a negative result. The synovium is the site of production of RF, but the degree of pathological change of the synovium of different joints in a single patient may not be uniform. The results of humoral immunity studies of the RA synovium may be influenced by the site selected for synovial biopsy.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
1991年第4期302-305,共4页
Acta Academiae Medicinae Sinicae
