自体免疫疾病.ppt
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1、自体免疫疾病,许秉宁,台大医学院免疫学研究所 台大医院内科部,器官特异性,非器官特异性,自体免疫疾病,肌肉,肾脏,皮肤,关节,Pathological Factors in Rheumatic Disorders,Rheumatic diseases are multisystem disorders caused by tissue damage resulting from autoantibodies, cytotoxic T lymphocytes, complement-fixing immune complex deposition, and inflammatory mediat
2、ors,Inflammatory Parameters,ESR Acute phase reactants Immunoglobulins Complement components Inflammatory mediators: cytokines, prostanoids,ESR are determined by the three forces,Surface free energy (Van de Waals force):cohesive force Electrical charge associated with RBC: repulsive force Dielectric
3、constant of the medium: dissipates the force,Calculation Equation for ESR,Vs=2/9x(Ps-PL)R2/n x g Vs= the limiting velocity of the sphere R= the radius of the sphere Ps and PL= the densities of the sphere and of the liquid g= the acceleration due to gravity n= the viscosity of the liquid,Serum Protei
4、ns and Drugs That Affect the ESR Rate,Acute Phase Reactants,The Acute Phase Response Follows Cell Injury and Tissue Damage Caused by: Acute infections: i.e., bacterial or parasitic Trauma: i.e., blunt, surgery, and burns Ischemic necrosis: i.e., acute myocardial infarction Malignant disease: I.e., t
5、umor growth and metastasis Connective tissue disease: i.e., rheumatoid arthritis, rheumatic fever and others Acute abdominal inflammation: i.e. cholecystitis and pancreatitis Vaccination: I.e., typhoid,Functional Properties of Human Acute Phase Proteins,C-Reactive Protein (CRP),Normal plasma protein
6、, concentration from 0.068-8.8 mg/ml Acute phase reactant, concentration up to 500mg/ml Synthesized by hepatocytes Molecular weight 105,500 daltons Five identical non-glycosylated, non-covalently associated subunits Amino acid sequence homologous with serum amyloid A component (SAA),Rheumatic Diseas
7、e in Which Elevated C-Reactive Protein Levels may Occur,c ACR,类风湿性关节炎(RA),类风湿性关节炎(RA),类风湿性关节炎是一种重要的自体免疫疾病,可导致关节破坏变形,骨骼变化以及全身性的病变。 类风湿性关节炎的骨骼变化包括发炎关节旁的骨缺乏,软骨侵蚀。 类风湿性关节炎是一种全身性的变化,患者不但关节疼痛,可能关节会逐渐变形。 过去十年来,类风湿关节炎在冶疗上的改变有着明显的进步。我们不再视其为一仅局限于关节的慢性病变;反之,却视为一甚富侵略性的全身性疾患。,Rheumatoid Arthritis (RA) A chronic,
8、 systemic, autoimmune, inflammatory disease of unknown etiology Characterized by persistent intense immunological activity inflammatory and erosive synovitis ,usually involving peripheral joint in a symmetric fashion local destruction of bone and cartilage a variety of systemic manifestation. The mo
9、st common inflammatory joint disease,Normal Synovium,Rheumatoid Synovium,c ACR,c Arthritis & Rheumatism Foundation,Page No.20/52,Clinical features of Rheumatoid Arthritis in the hand,Early,Wasting small muscles Extensor tendon sheath swelling Fusiform swelling of PIP joints MCP joint synovitis with
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