[The etiology and pathogenesis of autoimmune diseases].
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Biomedical subjects
Publications and source records attributed to S S Efuni.
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Immune status with reference to the disease duration and genetic factors (HLA-typing) was studied in various clinical variants of insulin-dependent diabetes mellitus. The disease duration appeared the key factor in development of immune deficiency in insulin-dependent diabetes mellitus. Critical immunological values were established (CD5+ cells--1200 in 1 microliter, CD4+ cells--35%, expression of CD5 and antigens HLA class II--110 and 75%, respectively) for septic complications which are highly probable in lower indices. Females with diffuse thyroid enlargement, subclinical hypothyroidism, wide spectrum of antibodies to DNA, antigenic determinants of thyroid gland, hypophysis were found to be a group associated with HLA--DR3 carriage.
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The paper is concerned with some data of investigation of the association of the HLA-system with the development of diffuse toxic goiter (DTG). An attempt was made to predict clinical variants of a course of DTG using HLA-antigens. Comparative analysis of the distribution of HLA-antigens was performed in 50 patients with various degrees of DTG severity, different therapeutic methods (operative and conservative) and outcomes of disease (postoperative hypothyrosis, DTG recurrence and euthyroid condition). The data obtained confirmed a high informative value of HLA-markers not only for predicting clinical variants of a DTG course, therapeutic methods but also for outcomes of therapy.
The paper is devoted to a study of the pathogenetic relationship of endocrine ophthalmopathy with thyroid diseases. Altogether 76 patients with endocrine ophthalmopathy combined with various thyroid lesions (diffuse toxic goiter, Hashimoto's disease, primary hypothyrosis) and without thyroid diseases were investigated. The serum level of thyroid hormones, the content of Ig A, M, G, thyroglobulin and the presence of antithyroid antibodies were analyzed. HLA typing by A, B, C, D2 loci was done for a group of patients. The results did not show correlation of the origin and gravity of ophthalmopathy either with thyroid function or with the factors determining thyroid affection. Some differences in the genetic markers of endocrine ophthalmopathy and autoimmune thyroid diseases were also established.
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Altogether 15 untreated patients aged 16 to 55 with diffuse toxic goiter had morphologically confirmed diagnosis of the presence of antibodies to Coxsackie virus (group B); titers of group A (1:128 and more) were revealed in 3 of them. It indicated recent (not more than 2 yrs.) Coxsackie virus infection. Such titers were absent in the control group (18 healthy persons). Difference in the study and control groups was statistically significant (p less than 0.05). The role of Coxsackie virus in the breakdown of natural tolerance to autologous thyroid tissue was discussed.
A total of 18 patients with Hashimoto's thyroiditis aged 20 to 57 were examined (16 females and 2 males). The control group included 267 healthy donors. Antigens of A, B, C and D loci of the HLA system were determined in all the patients. HLA Dr3 was determined in 14 (77.8%) of 18 patients (p less than 0.01). The relative disease risk in carriers of this antigen was 12.6. At the same time a 6-fold decrease in the frequency of HLA Dr2 was found in the patients. The authors discussed the problem of the predisposing role of HLA Dr3 in the development of autoimmune diseases and of the "protective" properties of HLA Dr2.
The paper presents data on the cellular and humoral immunity in different periods of insulin-dependent diabetes mellitus (with the disease standing of 0.5 +/- 0.4 years, group A; 3 +/- 1.8 years, group B; and 15 +/- 4 years, group C). Group A patients presented with the immunity system activation: increased counts of T cells, B lymphocytes, T helpers and T inductors, increased share of active T cells (that is, DR positive ones), elevated content of IgM, IgG, IgA (214 +/- 51 mg%, 1200 +/- 124 mg%, 250 +/- 34 mg%, respectively) as against the reference group (156 +/- 74, 914 +/- 387, 189 +/- 49 mg%, respectively) (p < 0.01). In group B patients, who suffered a longer disease, the immunity parameters were within the normal range, and in group C patients, in whom the disease standing was the longest, these shifts were contrary-wise as against those in group A, that is, T and B cell counts were lowered, as were the counts of T-helpers-inductors, Ig levels, and the phagocytosis index was 65 +/- 5 vs. 85 +/- 10% in the controls (p < 0.05), the phagocytosis level being 4 +/- 2 vs. 10 +/- 2 in the controls (p < 0.05). The authors analyze the association of the HLA system characteristics with the immunity shifts. Patients with the HLA A9, B8, B15, B18, DR3, DR4 presented with significant shifts in the immunity status as against those with the HLA A1, A10, B5, B12, B16, B27, DR5, DR7.(ABSTRACT TRUNCATED AT 250 WORDS)
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