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的免疫球蛋白，即：IgA、IgG、IgM^[3]、IgE^[4]或IgD^[5]。

检测

怀疑患有任何形式的关节炎及风湿病患者，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）或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]}：

全身性红斑狼疮 (SLE)^[12]
幼年特发性关节炎
干燥综合征^[12]
间质性肺纤维化
B型肝炎、C型肝炎、慢性肝病（英语：chronic liver disease）和慢性肝炎
冷凝球蛋白血症（英语：Essential mixed cryoglobulinemia）
原发性胆道性肝硬化（PBC）（英语：Primary biliary cirrhosis）
传染性单核白血球增多症和任何慢性病毒感染^[12]
细菌性心内膜炎（英语：Bacterial endocarditis）
麻风病^[13]
结节病^[12]
结核病
梅毒
内脏性（英语：Visceral leishmaniasis）利什曼病^[14]
疟疾
白血病
皮肌炎
全身性硬化（英语：Systemic sclerosis）
正常人在接种疫苗／输血后

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 Arthritis 于 eMedicine
[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]
存档副本. [2019-10-11]. （原始内容存档于2019-10-11）.^{[需要完整来源]}
[11]
The Arthritis Association （页面存档备份，存于互联网档案馆）, Report by MHC 19.2
[12]
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

类风湿因子/RF （页面存档备份，存于互联网档案馆）于 MedlinePlus
类风湿因子/RF （页面存档备份，存于互联网档案馆）于 Lab Tests Online
Rheumatoid Factor 于 eMedicine
类风湿因子/RF （页面存档备份，存于互联网档案馆）于 WebMD

[1] [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] [2]
Edkins A, Cushley W. The Jekyll and Hyde nature of antibodies. Biological Sciences Review. 2012, 25 (2): 4.

[3] [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] [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] [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] [6]
Rheumatoid Arthritis 于 eMedicine

[7] [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] [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.

[sd49-9] [9]
Rheumatoid Factor - Patient UK. [2019-10-11]. （原始内容存档于2012-02-07）.

[:7-10] [10]
存档副本. [2019-10-11]. （原始内容存档于2019-10-11）.^{[需要完整来源]}

[:8-11] [11]
The Arthritis Association （页面存档备份，存于互联网档案馆）, Report by MHC 19.2

[mayo-12] [12]
Rheumatoid factor - Mayo Clinic. [2019-10-11]. （原始内容存档于2021-05-26）.

[13] [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] [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] [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] [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.

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