신경질환자에서 AIT 검사의 임상적 유용성

Abstract

배경: 자가면역질환에서 중요하게 다뤄지고 있는 자가항체는 전신성 류마티스 질환의 진단과 추적관찰에 유용한 혈청학적 지표이다. 이 뿐만 아니라 악성종양이나 감염질환에서 검출되기도 한다. 신경질환에서는 최근까지 항신경성 항체 (anti-neuronal antibody) 에 관한 연구가 활발하게 진행되고 있지만, 전반적인 자가항체에 대한 포괄적 연구는 미미한 실정이다. 따라서 본 연구에서는 대표적 자가항체 선별검사인 자가면역표적 (autoimmune target, AIT) 검사를 이용해 각종 신경질환에서 자가항체와의 연관성을 알아보고자 하였다. 방법: 한양대학교병원 신경과 환자들 중 자가면역표적검사를 시행한 환자들에서 검사결과에 영향을 줄 수 있는 전신성 류마티스 질환, 악성종양, 감염질환은 제외하여 577명을 대상으로 하였다. 신경질환을 뇌경색, 루게릭병, 운동뉴런질환, 파킨슨병 등 7개의 군으로 나누어 양성률, 항체 역가, 형광 양상 등을 비교하고 분석하였다. 자가면역표적검사는 인간 대식세포에서 유래된 IT-1 세포를 기질로 하여 간접면역형광법으로 자가항체를 검출하는 방법이다. 결과: 전체 환자에서 자가항체 양성률은 74.5%로 높게 나타났다. 특히, 파킨슨병에서 84.8%, 루게릭병에서 83.9%, 운동뉴런질환에서 81.3%의 매우 높은 양성률을 보였다. 컷오프 값을 1:40으로 했을 경우 58.9%, 1:80에선 42.6%의 양성률을 보였다. 형광 양상의 개수는 단일 양상이 51.1%로 가장 많았고 두 가지의 복합 양상이 21.3%, 세 가지의 복합 양상이 2.1%를 차지했다. 형광 양상은 speckled 양상이 44%로 가장 빈번히 검출되었고, 다음으로는 MTOC-MT 양상이 21.3%로 두 번째로 빈번히 검출되는 양상이었다. MTOC-MT 양상은 루게릭병과 운동뉴런질환에서 특히 빈번하게 검출되었다. 결론: 각종 신경질환에서 높은 자가면역표적검사 양성률을 보았을 때, 항신경성 항체뿐만 아니라 전반적인 자가항체와 상당한 연관성을 가지고 있는 것으로 여겨진다. 특히 루게릭병과 운동뉴런질환에서는 MTOC-MT 양상이 빈번하게 검출되며, 이는 감염과의 연관성을 간접적으로 나타내는 것으로 볼 수 있다. 본 연구 결과들을 토대로 하여 앞으로 신경질환의 역학을 연구함에 있어서 방향성을 제시할 수 있을 것으로 사료된다.|Background : Autoantibodies which are the important markers of autoimmune disease are useful targets in diagnosis and following up of systemic autoimmune rheumatic diseases. Also, autoantibodies have strong association with malignancies and infectious diseases. In neurology, so many anti-neuronal antibodies come out having relationship with neurologic diseases. But, broad spectral study of association between autoantibodies and neurologic diseases is not well established. So, in this study, we would know that association between autoantibodies and neurologic diseases by AIT test which is a good screening test of autoantibody. Method : The subjects of this study are neurologic patients from Hanyang University Hospital. Total 577 patients who tested by AIT test were selected except systemic rheumatic disease, malignancy, infectious disease which could affect result of AIT test. Neurologic diseases divide into seven groups such as cerebral infarction, amyotrophic lateral sclerosis, motor neuron disease, Parkinson’s disease, et al. Positive rates, fluorescent patterns and titers of autoantibodies were compared and analyzed according to disease groups. AIT test is an indirect immunofluorescence method that uses IT-1 cell line originated from human macrophage as substrate. Result : Total positive rate was very high as 74.5%. Especially, positive rates of Parkinson’s disease, ALS, motor neuron disease are very high as 84.8%, 83.9%, and 81.3%. Total positive rate was 58.9% in cut-off value 1:40, and 42.6% in cut-off value 1:80. Positive in only single pattern was the most frequent (51.1%). Positive in two or more patterns also made up large number (23.4%). The speckled pattern is the most frequent (44%), and the MTOC-MT pattern was second most (21.3%). Moreover, MTOC-MT pattern was frequent in ALS and motor neuron disease. Conclusion : In this result of high positive rates of AIT test in these neurologic diseases, neurologic diseases have relations not only anti-neuronal antibodies also other many autoantibodies. Especially, MTOC-MT pattern was frequent in ALS and motor neuron disease. This shows relationship between ALS, motor neuron disease and infections, indirectly. On the basis of this study, we could signpost for the further studies of clear up the complete etiologies of neurologic diseases.; Background : Autoantibodies which are the important markers of autoimmune disease are useful targets in diagnosis and following up of systemic autoimmune rheumatic diseases. Also, autoantibodies have strong association with malignancies and infectious diseases. In neurology, so many anti-neuronal antibodies come out having relationship with neurologic diseases. But, broad spectral study of association between autoantibodies and neurologic diseases is not well established. So, in this study, we would know that association between autoantibodies and neurologic diseases by AIT test which is a good screening test of autoantibody. Method : The subjects of this study are neurologic patients from Hanyang University Hospital. Total 577 patients who tested by AIT test were selected except systemic rheumatic disease, malignancy, infectious disease which could affect result of AIT test. Neurologic diseases divide into seven groups such as cerebral infarction, amyotrophic lateral sclerosis, motor neuron disease, Parkinson’s disease, et al. Positive rates, fluorescent patterns and titers of autoantibodies were compared and analyzed according to disease groups. AIT test is an indirect immunofluorescence method that uses IT-1 cell line originated from human macrophage as substrate. Result : Total positive rate was very high as 74.5%. Especially, positive rates of Parkinson’s disease, ALS, motor neuron disease are very high as 84.8%, 83.9%, and 81.3%. Total positive rate was 58.9% in cut-off value 1:40, and 42.6% in cut-off value 1:80. Positive in only single pattern was the most frequent (51.1%). Positive in two or more patterns also made up large number (23.4%). The speckled pattern is the most frequent (44%), and the MTOC-MT pattern was second most (21.3%). Moreover, MTOC-MT pattern was frequent in ALS and motor neuron disease. Conclusion : In this result of high positive rates of AIT test in these neurologic diseases, neurologic diseases have relations not only anti-neuronal antibodies also other many autoantibodies. Especially, MTOC-MT pattern was frequent in ALS and motor neuron disease. This shows relationship between ALS, motor neuron disease and infections, indirectly. On the basis of this study, we could signpost for the further studies of clear up the complete etiologies of neurologic diseases.