類風濕因子

類風濕因子（英語：rheumatoid factor，RF）是首先在類風濕性關節炎上發現的自體抗體。它是針對IgG Fc 部分的抗體，且不同的 RF 針對 IgG-Fc 的不同部分^[1]。RF和IgG結合後，形成免疫複合體（英語：immune complex），進一步促成疾病形成^[2]。

類風濕因子也可以是一種冷凝球蛋白（英語：cryoglobulin）（一種在血液樣本冷卻時會沉澱的抗體）；它可以是第二型（單株 IgM 到多株 IgG）或第三型（多株 IgM 到多株 IgG）的冷凝球蛋白（英語：cryoglobulin）。

儘管類風濕因子主要以 IgM 形式存在，但它可以是任何一個同種型的免疫球蛋白，即：IgA、IgG、IgM^[3]、IgE^[4]或IgD^[5]。

檢測

懷疑患有任何形式的關節炎及風濕病患者，通常都會進行 RF 檢測；然而，結果陽性也可能由其他原因造成，且結果陰性也不能排除疾病。但是，結合體徵和症狀，在診斷和疾病預後評估時能發揮作用，它也是類風濕關節炎的常參考的疾病標準之一^[6]。

血清中檢測到類風濕因子，代表身體可能有自體免疫的問題，而與類風濕關節炎無關，例如：組織或器官排斥。此時，RF 可作為自體免疫的數種血清學標記之一^[7]。以 RF 診斷類風濕關節炎的敏感性只有 60-70％，特異性78％^[8]。

解讀

高濃度的 RF（通常，>20 IU/mL、1:40、或超過 95 百分位；不同檢驗單位間仍有差異）出現在類風濕關節炎（類風濕患者 80％會陽性）和乾燥症（其中的 70％陽性）^[9]。RF 的濃度愈高，關節破壞的可能性就越大^[10]^[11]。。愛潑斯坦-巴爾病毒（EBV）或細小病毒感染後可能陽性，健康人中（尤其是老人）有 5-10％會檢查陽性。

類風濕因子與關節炎持續惡化有關，造成更多的關節破壞，最終產生更嚴重的殘疾和關節炎^[10]^[11]。

除了類風濕關節炎外，以下情況也會出現類風濕因子檢查陽性^{[來源請求]}：

全身性紅斑狼瘡 (SLE)^[12]
幼年特發性關節炎
乾燥症候群^[12]
間質性肺纖維化
B型肝炎、C型肝炎、慢性肝病（英語：chronic liver disease）和慢性肝炎
冷凝球蛋白血症（英語：Essential mixed cryoglobulinemia）
原發性膽道性肝硬化（PBC）（英語：Primary biliary cirrhosis）
傳染性單核白血球增多症和任何慢性病毒感染^[12]
細菌性心內膜炎（英語：Bacterial endocarditis）
麻風病^[13]
結節病^[12]
結核病
梅毒
內臟性（英語：Visceral leishmaniasis）利什曼病^[14]
瘧疾
白血病
皮肌炎
全身性硬化（英語：Systemic sclerosis）
正常人在接種疫苗／輸血後

歷史

這個檢測由挪威的埃里克·沃勒（英語：Erik Waaler）（Erik Waaler）博士於1940年首次描述，並由哈利·M·羅斯（英語：Harry M. Rose）（Harry M. Rose）博士等於1948年重新描述。據說是因為第二次世界大戰帶來的不確定性才重新描述。目前仍被稱作沃勒－羅斯（Waaler-Rose）檢驗^[15]^[16]。

參考文獻

^ 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.
^ Edkins A, Cushley W. The Jekyll and Hyde nature of antibodies. Biological Sciences Review. 2012, 25 (2): 4.
^ 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.
^ 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.
^ 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.
^ Rheumatoid Arthritis 於 eMedicine
^ 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.
^ 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.
^ Rheumatoid Factor - Patient UK. [2019-10-11]. （原始內容存檔於2012-02-07）.
^ ^10.0 ^10.1 存档副本. [2019-10-11]. （原始內容存檔於2019-10-11）. ^{[需要完整來源]}
^ ^11.0 ^11.1 The Arthritis Association （頁面存檔備份，存於網際網路檔案館）, Report by MHC 19.2
^ ^12.0 ^12.1 ^12.2 ^12.3 Rheumatoid factor - Mayo Clinic. [2019-10-11]. （原始內容存檔於2021-05-26）.
^ 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.
^ 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.
^ 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.
^ 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.

外部連結

類風濕因子/RF （頁面存檔備份，存於網際網路檔案館）於 MedlinePlus
類風濕因子/RF （頁面存檔備份，存於網際網路檔案館）於 Lab Tests Online
Rheumatoid Factor 於 eMedicine
類風濕因子/RF （頁面存檔備份，存於網際網路檔案館）於 WebMD

[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 於 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.

[sd49-9] Rheumatoid Factor - Patient UK. [2019-10-11]. （原始內容存檔於2012-02-07）.

[:7-10] 10.0 ^10.1 存档副本. [2019-10-11]. （原始內容存檔於2019-10-11）. ^{[需要完整來源]}

[:8-11] 11.0 ^11.1 The Arthritis Association （頁面存檔備份，存於網際網路檔案館）, Report by MHC 19.2

[mayo-12] 12.0 ^12.1 ^12.2 ^12.3 Rheumatoid factor - Mayo Clinic. [2019-10-11]. （原始內容存檔於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.

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