类风湿因子

类风湿因子(英语:rheumatoid factor,RF)是首先在类风湿性关节炎上发现的自体抗体。它是针对IgG Fc 部分的抗体,且不同的 RF 针对 IgG-Fc 的不同部分[1]。RF和IgG结合后,形成免疫复合体英语immune complex,进一步促成疾病形成[2]

类风湿因子也可以是一种冷凝球蛋白英语cryoglobulin(一种在血液样本冷却时会沉淀的抗体);它可以是第二型(单株 IgM 到多株 IgG)或第三型(多株 IgM 到多株 IgG)的冷凝球蛋白英语cryoglobulin

尽管类风湿因子主要以 IgM 形式存在,但它可以是任何一个同种型免疫球蛋白,即:IgA、IgG、IgM[3]IgE[4]或IgD[5]

检测

怀疑患有任何形式的关节炎风湿病患者,通常都会进行 RF 检测;然而,结果阳性也可能由其他原因造成,且结果阴性也不能排除疾病。 但是,结合体征和症状,在诊断和疾病预后评估时能发挥作用,它也是类风湿关节炎的常参考的疾病标准之一[6]

血清中检测到类风湿因子,代表身体可能有自体免疫的问题,而与类风湿关节炎无关,例如:组织或器官排斥。此时,RF 可作为自体免疫的数种血清学标记之一[7]。以 RF 诊断类风湿关节炎的敏感性只有 60-70%,特异性78%[8]

解读

高浓度的 RF(通常,>20 IU/mL、1:40、或超过 95 百分位;不同检验单位间仍有差异)出现在类风湿关节炎(类风湿患者 80% 会阳性)和干燥症(其中的 70% 阳性)[9]。RF 的浓度愈高,关节破坏的可能性就越大[10][11]。 。爱泼斯坦-巴尔病毒(EBV)细小病毒感染后可能阳性,健康人中(尤其是老人)有 5-10% 会检查阳性。

类风湿因子与关节炎持续恶化有关,造成更多的关节破坏,最终产生更严重的残疾和关节炎[10][11]

除了类风湿关节炎外,以下情况也会出现类风湿因子检查阳性[来源请求]

历史

这个检测由挪威的埃里克·沃勒英语Erik Waaler(Erik Waaler)博士于1940年首次描述,并由哈利·M·罗斯英语Harry M. Rose(Harry M. Rose)博士等于1948年重新描述。据说是因为第二次世界大战带来的不确定性才重新描述。目前仍被称作沃勒-罗斯(Waaler-Rose)检验[15][16]

参考文献

  1. ^ Falkenburg, W.J.J. IgG Subclass Specificity Discriminates Restricted IgM Rheumatoid Factor Responses From More Mature Anti–Citrullinated Protein Antibody–Associated or Isotype-Switched IgA Responses. Arthritis & Rheumatology. November 2015, 67 (12): 3124–3134. PMID 26246004. doi:10.1002/art.39299. 
  2. ^ Edkins A, Cushley W. The Jekyll and Hyde nature of antibodies. Biological Sciences Review. 2012, 25 (2): 4. 
  3. ^ Hermann, E; Vogt, P; Müller, W. Rheumatoid factors of immunoglobulin classes IgA, IgG and IgM: Methods of determination and clinical value. Schweizerische Medizinische Wochenschrift. 1986, 116 (38): 1290–7. PMID 3775335. 
  4. ^ Herrmann, D; Jäger, L; Hein, G; Henzgen, M; Schlenvoigt, G. IgE rheumatoid factor. Occurrence and diagnostic importance in comparison with IgM rheumatoid factor and circulating immune complexes. Journal of Investigational Allergology & Clinical Immunology. 1991, 1 (5): 302–7. PMID 1669588. 
  5. ^ Banchuin, N; Janyapoon, K; Sarntivijai, S; Parivisutt, L. Re-evaluation of ELISA and latex agglutination test for rheumatoid factor detection in the diagnosis of rheumatoid arthritis. Asian Pacific Journal of Allergy and Immunology. 1992, 10 (1): 47–54. PMID 1418183. 
  6. ^ Rheumatoid ArthritiseMedicine
  7. ^ Rostaing, Lionel; Modesto, Anne; Cisterne, Jean Marc; Izopet, Jacques; Oksman, Françoise; Duffaut, Michel; Abbal, Michel; Durand, Dominique. Serological Markers of Autoimmunity in Renal Transplant Patients with Chronic Hepatitis C. American Journal of Nephrology. 1998, 18 (1): 50–6. PMID 9481439. doi:10.1159/000013304. 
  8. ^ Nishimura, K; Sugiyama, D; Kogata, Y; Tsuji, G; Nakazawa, T; Kawano, S; Saigo, K; Morinobu, A; Koshiba, M; Kuntz, KM; Kamae, I; Kumagai, S. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis.. Annals of Internal Medicine. 5 June 2007, 146 (11): 797–808. PMID 17548411. doi:10.7326/0003-4819-146-11-200706050-00008. 
  9. ^ Rheumatoid Factor - Patient UK. [2019-10-11]. (原始内容存档于2012-02-07). 
  10. ^ 10.0 10.1 存档副本. [2019-10-11]. (原始内容存档于2019-10-11). [需要完整来源]
  11. ^ 11.0 11.1 The Arthritis Association页面存档备份,存于互联网档案馆), Report by MHC 19.2
  12. ^ 12.0 12.1 12.2 12.3 Rheumatoid factor - Mayo Clinic. [2019-10-11]. (原始内容存档于2021-05-26). 
  13. ^ Garcia-De La Torre, Ignacio. Autoimmune phenomena in leprosy, particularly antinuclear antibodies and rheumatoid factor.. The Journal of Rheumatology. 1993, 20 (5): 900–3. PMID 8336322. 
  14. ^ Atta, AM. Serum markers of rheumatoid arthritis in visceral leishmaniasis: rheumatoid factor and anti-cyclic citrullinated peptide antibody.. Journal of Autoimmunity. 2007, 28 (1): 55–8. PMID 17257811. doi:10.1016/j.jaut.2006.12.001. 
  15. ^ Waaler, Erik. On the Occurrence of a Factor in Human Serum Activating the Specific Agglutination of Sheep Blood Corpuscles. Acta Pathologica et Microbiologica Scandinavica. 2009, 17 (2): 172–188. doi:10.1111/j.1699-0463.1940.tb01475.x.  reproduced in Waaler, E. On the Occurrence of a Factor in Human Serum Activating the Specific Agglutintion of Sheep Blood Corpuscles. APMIS. 2007, 115 (5): 422–38; discussion 439. PMID 17504400. doi:10.1111/j.1600-0463.2007.apm_682a.x. 
  16. ^ Rose, HM; Ragan, C. Differential agglutination of normal and sensitized sheep erythrocytes by sera of patients with rheumatoid arthritis. Proceedings of the Society for Experimental Biology and Medicine. 1948, 68 (1): 1–6. PMID 18863659. doi:10.3181/00379727-68-16375. 

外部链接