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类风湿关节炎中类风湿因子阳性的意义

2021-08-11 xiangting MedSci原创

类风湿因子(RF)是一种针对IgG Fc片段的自身抗体。约75%-80%的类风湿关节炎(rheumatoid arthritis, RA)患者在病程中的某些时段可以检出RF。

类风湿因子(RF)是一种针对IgG Fc片段的自身抗体。约75%-80%的类风湿关节炎(rheumatoid arthritis, RA)患者在病程中的某些时段可以检出RF。在RA患者中,类风湿因子通常用作诊断或预后指标。RF(尤其是高水平RF)可能先于RA临床症状出现。

                                          

RF特异性较低,其也可见于RA以外的疾病。例如系统性红斑狼疮(systemic lupus erythematosus, SLE)、原发性干燥综合征(Sjögren's syndrome, SS)等结缔组织病患者也可能存在RF。此外,RF水平升高还可见于某些感染性疾病(如疟疾、风疹、丙型肝炎)患者和预防接种后人群。

 

目前,临床上有助于诊断RA的生物标志物主要是RF和瓜氨酸肽抗体(antibodies to citrullinated peptides, ACPA)。有证据表明,存在RF预示着功能结局和影像学结局更差。然而,单一RF并没有足够的特异性来确诊RA,且无论是血清阳性或阴性,不同患者间的预后差异均较大。而在慢性多关节炎背景下,高滴度IgM型RF对RA诊断具有相对特异性。

 

尽管一些其他的诊断性检查(特别是ACPA)目前已广泛普及临床,IgM型RF检测仍在临床实践中占有一席之地。最终确诊为RA的患者中,有一小部分患者为RF阳性而ACPA阴性,尤其是在症状发作早期;因此同时检测RF和ACPA(而不是仅检测ACPA)可提高血清学检测确诊RA的敏感性和特异性。

 

有研究表明,与高滴度ACPA相比,高滴度RF似乎更能预测严重疾病进程,其与间质性肺病和血管炎等关节外表现相关性更强。RA患者在TNF(tumor necrosis factor)抑制剂治疗失败后,存在RF时,更可能对利妥昔单抗产生有临床意义的反应。

 

RF在疾病表现及活动性,以及关节侵蚀严重程度方面可能有一定预测价值。与血清阴性RA相比,RF阳性的关节病变更具侵袭性,且更常伴有关节外表现。

 

类风湿结节和血管炎几乎仅见于RF阳性患者;这些表现与死亡率增加有关。初始评估时RF阳性的患者影像学进展可能更迅速。针对一项病例对照研究(纳入135例早期RA女性患者)的一篇回顾性分析发现,平均随访6年时,RF持续阳性患者与血清阴性或间断血清阴性者相比,在关节侵蚀、结节、关节外疾病、功能障碍和疾病活动性方面更严重。

 

由此可见,类风湿因子与RA的疾病严重程度和进展方面存在一定相关性。

 

 

 

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    2021-08-13 lmm397
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    2021-08-12 ms4619351322408161

    学习了

    0

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    2021-08-12 学医无涯

    复习一下~

    0

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