Sistemik lupus eritematosusda immünoglobulinler ve dolaşan immün kompleksler

Abstract

Solid phase ELISA was used for the determination of immun comp lexes and their immunoglobulin content, radial immunodiffusion for se- rum immunoglobulin levels, indirect flourescent antibody assay for anti- nuclear antibodies and double-stranded DNA antibodies. Clq-binding immun complex levels of active and inactive lupus pa tients and controls were 40.59 u/ml, 36.93 u/ml, 11.84 u/ml respectively and the difference between active/inactive patients and controls were sig nificant (p<0.05); the difference between active and inactive peiod values of lupus patients was insignificant (p>0.05). IgG and IgM content of complexes measured as optical density values in active patients, inactive patients and controls were 2.11, 2.12, 1.78 for IgG and 0.967, 0.869, 0.794 for IgM respectively; the difference between IgG content of patients with active and inactive disease compared to controls was significant (p<0.05); The IgM content of immune complexes in active patients with respect to controls was also significantly different (p<0.05); but the difference bet ween active and inactive patients was not significant (p> 0.05). Serum immunoglobulin levels were found to be 19445 mg/L in active patients, 16846 mg/L in inactive patients and 15237 mg/L in controls. Only the serum IgG levels of active patients were significantly different from that of controls (p < 0.05). In the comparision of values of the patients classified as positive or negative with respect to each individual ACR criterion, the IgA content of immun complexes of patients with arthritis was significant ly less than that of patients without it (p<0.05). Consequently, the increase of immun complexes and their IgG and IgM content in active and inactive lupus patients; elevation in serum IgG levels without any significant difference in other isotypes were in agree ment with other previous researches.When the double-stranded DNA antibodies were taken as activity criterion, it has been seen that there was no relation with disease activity of circulating immun copmlexes, of the immunoglobulin content of complexes and of serum immunoglobulin levels. Clinical signs and symptoms did not correlate with immune comp lexes and serum immunoglobulins, except the IgA content of complexes in patients with arthritis being significantly less than that of patients without arthritis. 74 T.C. YÜKSEK&I:^Immün kompleksler ve komplekslerin immunoglobulin içeriğinin sap tanmasında solid faz ELISA, serum immün globulinlerinin ölçülmesinde radyal immünodifüzyon, antinükleer antikor ve çift sarmallı DNA antikor larının tayininde indirekt floresan antikor yöntemi kullanıldı. Hastaların aktif ve inaktif dönemleri ile kontrol grubunun Clq içeren immün kompleks düzeyleri sırasıyla 40.59 (J.g/ml, 36.93 ug/ml, 11.84 (ig/ml idi. Aktif ve inaktif hastalarla kontrol grubu arasındaki farkın önemli (p<0.05), hastaların aktif ve inaktif dönemleri arasındaki farkın ise önemsiz olduğu görüldü (p > 0.05). Aktif, inaktif hasta ve kontrol grupları nın immün komplekslerindeki IgG ve IgM içeriği optik dansite değeri ola rak sırasıyla 2.11, 2.12, 1.78 ve 0.967, 0.869, 0.794 olup hastaların aktif ve inaktif dönemleri ile kontrol grubu arasında IgG içeriği bakımından fark önemli (p < 0.05), aktif hastalarla kontrollar arasında IgM içeriği yönün den fark önemli (p<0.05), aktif ve inaktif hastalar arasındaki fark önemsiz bulunmuştur (p > 0.05). Serum immün globulin düzeyleri aktif hastalarda 19445 mg/L, inaktif hastalarda 16846 mg/L ve kontrol grubunda 15237 mg/L bulundu. Yalnızca aktif hastaların serum IgG düzeyi kontrol grubundan farklı bulundu (p < 0.05). ACR kriterleri yönünden pozitif ve negatif olan grupların birbiri ile yapılan karşılaştırmasında artriti olan hastaların immün komplekslerinin IgA içeriği artriti olmayan hastalardan düşük bulundu (p<0.05). Sonuç olarak, aktif ve inaktif lupuslu hastalarda dolaşan immün komplekslerin ve bu komplekslerin IgG ve IgM içeriğinin artması; serum IgG düzeyinin yükselmesi ama diğer isotiplerde önemli bir değişiklik olmaması daha önce yapılan diğer araştırmalarla paralellik göstermektedir. Çift sarmallı DNA antikorları aktivite kriteri olarak alındığında, serum dolaşan immün kompleks, immün komplekslerin immunoglobulin içeriği ve immün globulin düzeylerinin hastalık aktivitesi ile ilişkisinin olmadığı görülmüştür. Klinik bulgu ve belirtilerle immün kompleksler ve immüno- globulinler arasında, artritli hastalardaki immün komplekslerin IgA içeri ğinde artriti olmayanlara göre azalma dışında bir ilişki görülmemiştir.

Key words: Lupus erythematosus (systemic), immune globulins, antibodies, autoantibodies, immune complexes. ABSTRACT Although several hypothesis were devised for its etiology, systemic lu pus erithematosus is yet a systemic inflammatory disease of unknown etiology. Immunopathogenesis of lupus, accepted as the prototype of im mune complex diseases, were explained with the complement dependent inflammation caused by immun complexes. In this study, Clq-binding immune complexes, immunoglobulin con tent of complexes and serum immune globulin levels were investigated in the sera of active and inactive lupus patients and that of healthy controls. Double-stranded DNA antibodies were taken as the activity criterion a- long with the clinical signs and symptoms indicating activity. Fifty pa tients (47 women, 3 men) with an elevated double-stranded DNA anti body titer costituted the active group of lupus patients (mean age 29.2 years); 10 patients from this group recovered afterwards with double- stranded DNA antibody conversion constituted the group of inactive patients; and 30 healthy people served as controls (mean age 33.1 years). 30 patients selected from active group were classified with respect to their positivity or negativity of each individual ACR criterion and were com pared to each other for the serum values of Clq- binding immun complex es, their immunoglobulin content and serum immunoglobulin levels. 73Solid phase ELISA was used for the determination of immun comp lexes and their immunoglobulin content, radial immunodiffusion for se- rum immunoglobulin levels, indirect flourescent antibody assay for anti- nuclear antibodies and double-stranded DNA antibodies. Clq-binding immun complex levels of active and inactive lupus pa tients and controls were 40.59 u/ml, 36.93 u/ml, 11.84 u/ml respectively and the difference between active/inactive patients and controls were sig nificant (p<0.05); the difference between active and inactive peiod values of lupus patients was insignificant (p>0.05). IgG and IgM content of complexes measured as optical density values in active patients, inactive patients and controls were 2.11, 2.12, 1.78 for IgG and 0.967, 0.869, 0.794 for IgM respectively; the difference between IgG content of patients with active and inactive disease compared to controls was significant (p<0.05); The IgM content of immune complexes in active patients with respect to controls was also significantly different (p<0.05); but the difference bet ween active and inactive patients was not significant (p> 0.05). Serum immunoglobulin levels were found to be 19445 mg/L in active patients, 16846 mg/L in inactive patients and 15237 mg/L in controls. Only the serum IgG levels of active patients were significantly different from that of controls (p < 0.05). In the comparision of values of the patients classified as positive or negative with respect to each individual ACR criterion, the IgA content of immun complexes of patients with arthritis was significant ly less than that of patients without it (p<0.05). Consequently, the increase of immun complexes and their IgG and IgM content in active and inactive lupus patients; elevation in serum IgG levels without any significant difference in other isotypes were in agree ment with other previous researches.When the double-stranded DNA antibodies were taken as activity criterion, it has been seen that there was no relation with disease activity of circulating immun copmlexes, of the immunoglobulin content of complexes and of serum immunoglobulin levels. Clinical signs and symptoms did not correlate with immune comp lexes and serum immunoglobulins, except the IgA content of complexes in patients with arthritis being significantly less than that of patients without arthritis. 74 T.C. YÜKSEK&I:^