扩张型心肌病HLA－DRB_1基因多态性的研究

借助聚合酶链反应（ＰＣＲ）／序列特异性引物（ＳＳＰ）技术对４２例扩张型心肌病（ＤＣＭ）患者和１６８例正常对照者进行人类白细胞抗原（ＨＬＡ）－ＤＲＢ１基因型分析。结果发现ＤＣＭ组ＨＬＡ－ＤＲＢ１＊１１基因频率与对照组比较明显增高（２６．１９％对１３．１％，Ｐ＜０．０５），其ＲＲ＝２．３６。其他等位基因频率在ＤＣＭ组与对照组间差异无显著性。提示ＨＬＡ－ＤＲＢ１＊１１基因可能与ＤＣＭ有关联。     

HLA—DRB1等位基因与我国北方类风湿关节炎的关系

为了观察ＨＬＡ－ＤＲＢ１等位基因在类风湿关节炎（ＲＡ）临床及发病中的作用，对８６例ＲＡ患者和１０６名正常对照的ＨＬＡ－ＤＲＢ１等位基因进行分型。用序列特异性引物体外基因扩增法测定ＨＬＡ－ＤＲ特异性，用序列特异性寡核苷酸探针进行ＨＬＡ－ＤＲ４亚型的测定。并根据ＨＬＡ－ＤＲＢ１等位基因的分型结果分析ＲＡ的临床表现和血清学特点及其与ＲＡ患者预后的关系。结果表明：同对照组相比，ＲＡ患者中ＨＬＡ－ＤＲ４基因频率明显增高（４８．８％比１７．９％，Ｐ＜０．００１），而ＨＬＡ－ＤＲ５基因频率降低（１６．３％比２７．４％，Ｐ＝０．０６）。ＤＲ４阳性ＲＡ中主要的ＤＲ４亚型为ＨＬＡ－ＤＲＢ１＊０４０５（６１．９％比２１．１％，Ｐ＜０．０１）。在ＤＲ４阳性和ＤＲ４阴性两组患者中，其发病年龄、病程和关节外表现无明显差异，但ＤＲ４阳性组的类风湿因子阳性率高于ＤＲ４阴性组（Ｐ＜０．０５），并且ＤＲ４阳性的ＲＡ患者腕和（或）指关节Ｘ线片分期明显重于ＤＲ４阴性者（Ｐ＜０．０５）。本研究结果表明，我国北方ＲＡ患者和ＨＬＡ－ＤＲ４基因明显相关，其主要亚型为ＨＬＡ－ＤＲＢ１＊０４０５。ＲＡ患者ＨＬＡ－ＤＲ４基因的检测可作为一项有用的预后判断指标。     

HLA—DR基因与我国北方汉族肺结核的相关性研究

目的 探讨我国北方汉族ＨＬＡ－ＤＲ基因多态性与肺结核（ＰＴＢ）的遗传关联性及其与临床表现的关系。方法 本研究采用联合酶链反应－序列特异性引物（ＰＣＲ－ＳＳＰ）方法,对７４例ＰＴＢ患者及９０例正常人的ＨＬＡ－ＤＲ等位基因进行分型。结果 与对照组相比,ＰＴＢ患者组的ＤＲＢ１＊１５等位基因频率显著增高（３４．３％比１７．０％,Ｐｃ〈０．０５,ＲＲ＝２．９１）,ＨＬＡ－ＤＲＢ１＊１２基因频率增高（１５．４     

广东汉人HLA—DRB1基因的PCR—SSP定型分析及其对风湿热遗传 …

目的：研究了ＨＬＡ－ＤＲＢ１基因对风湿热的遗传易感性，方法；用ＰＣＲ－ＳＳＰ方法对广东地区５１例风湿热患者和１０２位正常人的ＨＬＡ－ＤＲＢ１基因进行定型分析且探讨ＨＬＡ－ＤＲＢ１等位基因与风湿热的相关性。结果：风湿热患者ＨＬ－ＡＤＲＢ１等位基因分布异常喏上素ＤＲＢ１＊０３０１基因频率为２３．３％，而正常人仅为６．５９％。     

HLA—DR2,DRB1＊0301,DQA1＊0501基因频率与肌炎及其临床表现的 …

目的：观察人类白细胞相关抗原ＨＬＡ－ＤＲ２，ＤＲＢ１＊０３０１，ＤＱＡ１＊０５０１基因频率为多发性肌炎／皮肌炎（ＰＭ／ＤＭ）发病及其临床表现的关系，方法：特异性引物聚合酶链式反应（ＰＣＲ－ＳＳＰ）方法分别测定了３１例ＰＭ／ＤＭ患者及５０例正常人的ＨＬＡ－ＤＲ２，ＤＲＢ１＊０３０１及ＨＬＡ－ＤＡＱ１＊０５０１的基因频率，结果：三种基因型在３１例肌炎患得中基频率分别为：６．４５％，９．６８％和７７．４     

HLA—DR.DQ基因与骨关节结核的易感性研究

目的 探讨ＨＬＡ－ＤＲ．ＤＱ基因多态性与骨关节结核的遗传关联性,比较骨关节结核与肺结核之间易感基因的差异。方法 采用聚合酶链反应－序列特异性引物（ＰＣＲ－ＳＳＰ）方法,对８６例骨关节结核。８８例正常人及３４例肺结核的ＨＬＡ－ＤＲ．ＤＱ等位基因进行分析。结果 骨关节结核组与正常人比较,骨关节结核组ＤＲＢ１＊０９、ＤＱＢ１＊０３０１基因频率增高（３８．９９％比８．２４％ ＰＣ〈０．０００１ＲＲ＝８．９     

HLA—II类基因与红斑狼疮自身抗体相关性研究

目的 分析ＨＬＡ－Ⅱ类等位基因与自身抗体的相关性,探讨系统性红斑狼疮的自身抗体反应类型。方法 应用聚合酶链反应／序列特异寡核苷酸探针杂交（ＰＣＲ－ＳＳＯＰＨ）检测技术对１１３例确诊ＳＬＥ病人进行ＨＬＡ－ＤＲ、ＤＱＡ１和ＤＱＢ１基因分型。结果 抗ｄｓＤＮＡ与ＤＱＢ１＊１６０１和ＤＲＢ３＊０３０１负相关;ＡＮＡ与ＤＲＢ３＊０２０２和ＤＱＡ１＊０５０１正相关;抗ＲＮＰ与ＤＱＡ１＊０３０１正相关,与ＤＱＡ     

HLA—DRB1和DQ基因与胰岛素依赖型糖尿病遗传易感相关性的联合研究

用ＰＣＲ及序列特异性寡核苷酸针杂交技术对中国北方人中ＨＬＡ－ＤＲＢ１和ＤＱ基因与ＩＤＤＭ的遗传易感相关性联合进行了研究。以５４例胰岛素依赖型糖尿病患儿为研究对象，４０例正常成年供血员为对照，结果表明：ＤＲＢ１＊０３０１、ＤＱＡ１＊０５０１、０３０１和ＤＱＢ１＊０２０１为ＩＤＤＭ易感性基因，ＤＱＡ１＊０１０３、ＤＱＢ１＊ＤＱＢ１＊０６０１为ＩＤＤＭ保护性基因。ＤＲＢ１＊０３０１－ＤＱＡ１＊０５０１－     

大动脉炎易感性与HLA-DRB基因相关性研究

目的 探讨大动脉炎易感性与ＨＬＡ－ＤＲＢ等位基因频率的相关性。方法 以８４例汉族大动脉炎患和１０２例健康汉族人（对照组）为研究对象,采用ＰＣＲ－ＳＳＰ及ＰＣＲ－ＲＦＬＰ方法进行ＨＬＡ－ＤＲＢ等位基因分型,比较其等位基因频率在大动脉炎患与对照组之间的差异。结果 ＨＬＡ－ＤＲ４、ＤＲ７等位基因频率在大动脉炎组显高于对照组（３８．１％比１５．７％,Ｐ〈０．０１,ＲＲ＝２．４３;４７．６％比１０．８     

系统性红斑狼疮多发家系与HLA致病单倍型研究

目的 探讨系统性红斑狼疮（ＳＬＥ）的发病机制和分子遗传基础。方法 用聚合酶链反应结合顺序特异的寡核苷酸（ＰＣＲ／ＳＳＯ）探针杂交方法对５个ＳＬＥ多发家系和８０例无亲缘关系的ＳＬＥ患者ＨＬＡ－ＤＲ、ＤＱ亚区作ＤＮＡ分型。结果 发现ＳＬＥ中ＨＬＡ－ＤＲＢ１＊１５０１，ＤＱＡ１＊０１０２等位基因频率及ＨＬＡ－ＤＲＢ１＊１５０１，ＤＱＡ１＊０１０２，ＤＱＢ１＊０６０２单倍型频率均显著升高，提示该单倍型可能     

Narcolepsy in Hong Kong Chinese - a preliminary experience

Background : Narcolepsy is a sleep disorder of unknown aetiology. Despite the widely reported strong association with HLA DR2 among different ethnic groups and their varying prevalence rates, there has never been any series of laboratory documented narcolepsy in Chinese.
Aims : To report the preliminary experience with Chinese narcoleptic patients and their HLA typing.
Methods : The records of 342 patients who presented to our sleep laboratory for various sleep problems from 1986 to 1992 were examined. Both clinical and polysomnographic data were analysed. The criteria for a diagnosis of narcolepsy is based on shortened mean sleep latency of less than 5 minutes and presence of rapid eye movement (REM) sleep in two or more of the five 20-minute naps during multiple sleep latency test (MSLT).
Results : There were five narcoleptic patients documented resulting in an overall laboratory prevalence of 1.5% or 2.3% of patients presenting with hypersomnia. All patients were HLA DR2 positive.
Conclusion : There is 100% association with HLA DR2 in Hong Kong Chinese narcoleptic patients. Based on the laboratory prevalence, the prevalence rate of narcolepsy among Hong Kong Chinese population is estimated to be within the range of four in 10,000 to one in 100,000.     

HLA association of amoxicillin-clavulanate--induced hepatitis.

BACKGROUND & AIMS: Drug-induced immunoallergic hepatitis typically affects a minority of patients exposed to a particular drug. Its rarity is believed to be due to metabolic or immunologic idiosyncrasy. The presence of an immunologic idiosyncrasy might imply an HLA association. Previous studies reporting an HLA association of drug-induced hepatitis included only small numbers of patients and used serological HLA typing. METHODS: We studied 35 patients with biopsy-documented amoxicillin-clavulanate-induced hepatitis. HLA-A and -B were typed using alloantisera and compared with those of 300 controls (volunteer bone marrow donors). HLA-DRB and -DWB were typed by polymerase chain reaction-line probe assay, with 60 volunteer bone marrow donors serving as controls. RESULTS: The study group was characterized by a higher frequency of DRB1*1501-DRB5*0101-DQB1*0602 haplotype (57.1% vs. 11.7% in controls, P < 0.000005; after correction for the large number of comparisons, P < 0.0002). Patients with DRB1*1501-DRB5*0101-DQB1*0602 haplotype were more likely than patients without it to have a cholestatic (70% vs. 60%) or mixed (30% vs. 13%) than a hepatocellular pattern of hepatitis (0% vs. 27%) (P < 0.05). CONCLUSIONS: Amoxicillin-clavulanate-induced hepatitis is associated with the DRB1*1501-DRB5*0101-DQB1*0602 haplotype. The data support the view that an immunologic idiosyncrasy, mediated through HLA class II antigens, plays a role in the pathogenesis of drug-induced immunoallergic hepatitis. HLA association has a limited impact on the expression of hepatitis.     

Juvenile idiopathic arthritis and HLA Class I and Class II interactions and age‐at‐onset effects

Objective

The aim of this study was to quantitate risk and to examine heterogeneity for HLA at high resolution in patients with the most common subtypes of juvenile idiopathic arthritis (JIA), IgM rheumatoid factor–negative polyarticular JIA and oligoarticular JIA. Use of 4‐digit comprehensive HLA typing enabled great precision, and a large cohort allowed for consideration of both age at disease onset and disease subtype.

Methods

Polymerase chain reaction–based high‐resolution HLA typing for class I and class II loci was accomplished for 820 patients with JIA and 273 control subjects. Specific HLA epitopes, potential interactions of alleles at specific loci and between loci (accounting for linkage disequilibrium and haplotypic associations), and an assessment of the current International League of Associations for Rheumatology classification criteria were considered.

Results

An HLA–DRB1/DQB1 effect was shown to be exclusively attributable to DRB1 and was similar between patients with oligoarticular JIA and a younger subgroup of patients with polyarticular JIA. Furthermore, patients with polyarticular JIA showed age‐specific related effects, with disease susceptibility in the group older than age 6 years limited to an effect of the HLA–DRB1*08 haplotype, which is markedly different from the additional susceptibility haplotypes, HLA–DRB1*1103/1104, found in the group with oligoarticular JIA and the group of younger patients with polyarticular JIA. Also in contrast to findings for oligoarticular JIA, patients with polyarticular arthritis had no evidence of an HLA class I effect. Markers associated with a reduced risk of disease included DRB1*1501, DRB1*0401, and DRB1*0701. DRB1*1501 was shown to reduce risk across the whole cohort, whereas DRB1*0401 and DRB1*0701 were protective for selected JIA subtypes. Surprisingly, the disease predisposition mediated by DPB1*0201 in individuals without any disease‐predisposing DRB1 alleles was great enough to overcome even the very strong protective effect observed for DRB1*1501.

Conclusion

Inherited HLA factors in JIA show similarities overall as well as differences between JIA subtypes.

     

Evidence for HLA-related susceptibility for stroke in children with sickle cell disease

Cerebral infarction occurs in one quarter of all children with sickle cell anemia (SCA). There is an increased risk of stroke in siblings with SCA, suggesting genetic factors may influence risk of stroke. The authors investigated whether HLA type was associated with risk of stroke in children with SCA. Fifty-three patients with SCA underwent complete HLA typing at both HLA class I (HLA-A, B) and HLA class II (HLA-DR, DQ, DP) loci. Of the 53 patients, 22 had magnetic resonance imagining (MRI)-documented evidence of cerebral infarction, and the remaining 31 patients had negative MRI scans. Comparison of the results of HLA typing between the SCA patients with a positive and those with a negative MRI documented that the 2 groups differed with respect to the class I HLA-B (P =.012), and the class II HLA-DRB1 (P =.0008) and DQB1 (P =.029). Susceptibility associations at the HLA-DRB1 locus included both DR3 alleles, where DRB1*0301 and *0302 were both associated with an increased risk of stroke. Protective associations were found in the DR2 group, where DRB1*1501 was protective for stroke. DQB1*0201, which is in linkage disequilibrium with DRB1*0301, was also associated with stroke. Similarly, DQB1*0602, in linkage disequilibrium with DRB1*1501, was protective. Specific HLA alleles may influence the risk of stroke in children with SCA. HLA typing may prove useful in identifying SCA patients at higher risk for stroke.     

Molecular analysis of major histocompatibility complex allelic associations with systemic lupus erythematosus in Taiwan

Objective. To investigate the association of HLA class II alleles/haplotypes, type I C2 deficiency gene, and tumor necrosis factor α gene promoter allele (TNF2) with systemic lupus erythematosus (SLE) in the Chinese population in Taiwan. Methods. The HLA-DRB1 and DQB1 alleles were studied in 105 SLE patients and 115 controls by the polymerase chain reaction (PCR)/sequence-specific oligonucleotide probe method, the subtyping of DRB1*15/16 and DRB5 by PCR with sequence-specific primers, type I C2 deficiency gene by PCR, and TNF2 by PCR-Nco I restriction fragment length polymorphism. Results. The frequencies of the HLA class II alleles DRB1*02, DRB1*1502, DRB5*0102, DQB1*0501, and DQB1*0602 and DR2-associated haplotypes DRB1* 1501,DRB5*0101,DQB1*0602 and DRB1*1502,DRB5* 0102,DQB1*0501 were higher among SLE patients than among controls; however, only DQB1*0501 was statistically significantly associated with SLE. No specific allele/haplotype was significantly associated with lupus nephritis. No subject had type I C2 deficiency. SLE patients had a marginally higher percentage of TNF2, which was in linkage disequilibrium with DR3. Since DR3 was not associated with SLE in this Taiwanese Chinese population, TNF2 might play a role in the immunopathogenesis of SLE. Conclusion. Although no HLA-DRB1 allele was found to be significantly associated with SLE, the associations with DQB1*0501 and TNF2 suggest that DQB1 and tumor necrosis factor α may be important genetic factors in SLE susceptibility in the Chinese population in Taiwan.     

Exploring the impact of a decision support intervention on vascular access decisions in chronic hemodialysis patients: study protocol

Background

Human leukocyte antigen (HLA) alleles are associated with many autoimmune diseases, including anti-glomerular basement membrane (GBM) disease. In our previous study, it was demonstrated that HLA-DRB1*1501 was strongly associated with anti-GBM disease in Chinese. However, the association of anti-GBM disease and other HLA class II genes, including HLA-DQB1, -DQA1,-DPB1 alleles, has rarely been investigated in Asian, especially Chinese patients. The present study further analyzed the association between anti-GBM disease and HLA-DQB1, -DQA1, and -DPB1 genes. Apart from this, we tried to locate the potential risk amino acid residues of anti-GBM disease.

Methods

This study included 44 Chinese patients with anti-GBM disease and 200 healthy controls. The clinical and pathological data of the patients were collected and analyzed. Typing of HLA-DQB1, -DQA1 and -DPB1 alleles were performed by bi-directional sequencing of exon 2 using the SeCoreTM Sequencing Kits.

Results

Compared with normal controls, the prevalence of HLA-DPB1*0401 was significantly lower in patients with anti-GBM disease (3/88 vs. 74/400, p = 4.4 × 10^-4, pc = 0.039). Comparing with normal controls, the combination of presence of DRB1*1501 and absence of DPB1*0401 was significantly prominent among anti-GBM patients (p = 2.0 × 10^-12, pc = 1.7 × 10^-10).

Conclusions

HLA-DPB1*0401 might be a protective allele to anti-GBM disease in Chinese patients. The combined presence of DRB1*1501 and absence of DPB1*0401 might have an even higher risk to anti-GBM disease than HLA-DRB1*1501 alone.     

HLA-patterns in patients with multiple sclerosis and type I diabetes mellitus: evidence for possible mutual exclusion of both diseases

BACKGROUND: Type I diabetes mellitus (T1DM) and multiple sclerosis (MS), both immune-mediated diseases, rarely co-exist in the same individual or co-segregate in families. HLA susceptibility genes for T1DM (DRB1*0401, DRB1*0404, DQB1*0302, DRB1*0301, DQB1*0201) rarely occur in MS patients. HLA genes known to confer "resistance" to T1DM (DRB1*1501, DQB1*0602-DQA1*0102) predispose to MS. To test the hypothesis of mutually exclusive HLA patterns, patients affected by T1DM plus MS were compared to those of patients affected by either of the diseases alone in a case-control study. METHODS: Blood was sampled for analysis of HLA class I and class II alleles from 66 patients of German ancestry, of whom 33 had T1DM plus MS, and 33 had MS-only. For comparison to patients with T1 DM-only we referred to published data. HLA typing was performed using conventional serology (immuno-magnetic beads) and genotyping (SSP-PCR Dynal(R) SSP low/high resolution kits). RESULTS: Individuals with co-existing MS plus T1DM displayed the expected T1DM associated HLA-pattern (75.8% carried DRB1*04, 69.7% carried DQB1*0302, 42% were DR4, DR3 heterozygous), but failed to display the expected MS associated HLA-pattern (0% carried DQB1*0602, 3.1% carried DQA1*0102).The expected MS associated HLA-pattern of Caucasoid patients, however, was found in the MS-only patients (42% carried DRB1*1501-DQB1*0602, 58% carried DQA1*0102), while the prevalence of T1DM susceptibility and 'resistance' alleles was not different from the general population. The allele frequency of DRB1*1501 was 16/66, 24.2% in the 33 MS-only patients, and 0% in the 33 MS plus T1DM patients. The allele frequency of DQB1*0602 was 16/66, 24.2% in the 33 MS-only patients, and 0% in the 33 MS plus T1DM patients. The allele frequency of DQA1*0102 was 18/66, 27.3%, in the 33 MS-only patients, and 1/66 1.5% in the 33 MS plus T1DM patients. CONCLUSION: These data confirm the hypothesis of mutually exclusive HLA-patterns of T1DM and MS, and are consistent with a low rate of co-morbidity of both diseases.     

HLA class II alleles in Japanese patients with non-Hodgkin's lymphoma

The distribution of HLA-DRB1 alleles and DQB1 alleles in 30 Japanese patients with non-Hodgkin's lymphoma (NHL) was analyzed using polymerase chain reaction with the sequence-specific primer (PCR-SSP) method, and the association between the disease and the presence of certain HLA class II alleles was investigated. The frequencies of HLA-DRB1*0803, DRB1*0802 and DRB1*1502 were increased while those of DRB1*1501 and DRB1*0405 were decreased. On the other hand, the incidence of HLA-DQB1 alleles was similar to that in the normal population. However, none of these HLA class II alleles showed significant positive or negative associations with NHL. In addition, when allele frequencies of NHL Japanese patients were compared to Thai patients, only DRB1*0803 was significantly increased in Japanese patients. These results indicate that DRB1*0803 may not contribute to NHL susceptibility in the Japanese population. However, further studies with larger numbers of NHL Japanese patients are needed to confirm our preliminary findings.     

抗甲状腺药物致白细胞减少易感性与HLA-DRB1基因多态性及ANCA的关联性

目的 研究安徽地区汉族Graves病患者使用抗甲状腺药物(ATD)致白细胞减少的易感性与HLA-DRB1基因多态性及抗中性粒细胞胞浆抗体(ANCA)的相关性.方法 采用聚合酶链反应-序列特异性引物方法(PCR-SSP)检测76例ATD致白细胞减少的Graves病患者、98例ATD治疗后白细胞正常患者和230名健康对照者的等位基因HLA-DRB1* 08032、DRBI* 1501、DRB1*0901的频率.采用间接免疫荧光法(IIF)检测白细胞减少组和白细胞正常组Graves病患者的血清ANCA阳性率.结果 (1)与健康对照组及细胞正常组比较,白细胞减少组患者等位基因DRB1 * 08032、DRB1*1501频率明显增加(OR分别为3.06,1.77,4.03和2.28,均P＜0.05),DRB1* 0901频率明显减低(OR为0.33和0.43,P＜0.05).(2)与甲巯咪唑治疗后白细胞正常组患者比较,甲巯咪唑致白细胞减少组患者血清ANCA阳性率明显增加(x2 =4.878,P＜0.05).(3)与未携带等位基因DRB1*08032和DRB1*1501的患者比较,携带者血清中ANCA阳性率明显增加(x2为5.682,5.429,4.009和4.549,均P＜0.05).结论 等位基因HLA-DRB1*08032、HLA-DRB1*1501可能是安徽地区汉族人ATD致白细胞减少的易感基因;HLA-DRB1*0901可能是其保护基因或抗性基因.免疫反应可能参与了ATD致白细胞减少的发生.免疫反应的发生可能存在遗传易感性.     

Sleepiness that cannot be overcome: Narcolepsy and cataplexy

Narcolepsy–cataplexy syndrome is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disturbed nocturnal sleep. It is strongly associated with the genetic marker, human leucocyte antigen (HLA) DQB1*06:02. A deficit in the endogenous hypocretin/orexin system due to neuronal degeneration in the lateral hypothalamus, induced by an autoimmune‐mediated process, is the primary pathophysiology associated with the human disease. The important finding of an association with hypocretin genes in animal models of narcolepsy has led to the establishment of cerebrospinal fluid hypocretin measurements as a new diagnostic test for human narcolepsy. This is a fascinating story of translation of basic science research into clinical practice in sleep medicine during the past decade. Recent advances have shed light on the associations between respiratory medicine and narcolepsy–cataplexy research. The first is that upper airway infections, including H1N1 and/or streptococcal infections, may initiate or reactivate an immune response that leads to loss of hypocretin‐secreting cells and narcolepsy in genetically susceptible individuals. The second is that an increased incidence of sleep disordered breathing among narcoleptic subjects may relate to the impairment of central control of breathing, linked to hypocretin deficiency or carriage of HLADQB1*06:02, in animals and human subjects with narcolepsy, respectively, indicating neural dysfunction in an area where respiratory and sleep–wake systems are closely interrelated.