Department of Internal Medicine F and the Department of Rheumatology, Tel Aviv Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel.
Arthritis Res Ther. 2010;12(1):R12. doi: 10.1186/ar2913. Epub 2010 Jan 25.
Patients with tuberculosis (TB) frequently produce anti-citrullinated protein antibodies (ACPA). The objective of this study is to characterize the citrulline-dependence of the ACPA reactivity in sera of patients with mycobacterium infections.
Serum samples of 134 patients with untreated mycobacterium infections (122 TB, 12 nontuberculous mycobacterium) were tested for antibodies against both the citrullinated (Cit) and the non-citrullinated (Arg) form of 2 cyclic synthetic peptides. In 33 patients, a follow-up sample was tested six months after starting anti-mycobacterial drugs.
A substantial proportion of patients with mycobacterial infections demonstrated antibodies against 0401Cit, 0401Arg, 0722Cit and 0722Arg. Fourteen patients demonstrated anti-0401Cit, 83 anti-0401Arg, 22 anti-0722Cit and 61 anti-0722Arg, while none of these antibodies were detected in the 20 healthy controls. All the patients but one, who were anti-0401Cit and anti-0722Cit positive, demonstrated reactivity against the respective Arg peptide. In the subset of 33 patients with a follow-up test six months after starting treatment, the mean levels of antibodies to 0401Cit, 0401Arg, 0722Cit and 0722Arg significantly decreased after treatment. All the patients who were anti-0401Cit and anti-0722Cit positive turned negative after treatment. The presence of anti-0401Cit/Arg and anti-0722Cit/Arg was found to be significantly correlated with the presence of HIV.
ACPA may be found in patients with TB. In most of the cases, the reactivity is citrulline independent. A positive cyclic citrullinated peptide (CCP) test in these patients should therefore be interpreted with care, and preferably followed by a control ELISA with a non-citrullinated antigen.
结核病（TB）患者常产生抗瓜氨酸蛋白抗体（ACPA）。本研究的目的是描述分枝杆菌感染患者血清中 ACPA 反应对瓜氨酸的依赖性。
检测了 134 例未经治疗的分枝杆菌感染患者（122 例结核，12 例非结核分枝杆菌）血清中的抗两种环合成肽的瓜氨酸化（Cit）和非瓜氨酸化（Arg）形式的抗体。在 33 例患者中，在开始抗分枝杆菌药物治疗六个月后检测了随访样本。
相当一部分分枝杆菌感染患者表现出针对 0401Cit、0401Arg、0722Cit 和 0722Arg 的抗体。14 例患者表现出抗 0401Cit，83 例患者抗 0401Arg，22 例患者抗 0722Cit，61 例患者抗 0722Arg，而 20 例健康对照者均未检测到这些抗体。除了一位既抗 0401Cit 又抗 0722Cit 的患者外，所有患者均表现出针对相应 Arg 肽的反应性。在开始治疗后六个月进行随访测试的 33 例患者亚组中，治疗后 0401Cit、0401Arg、0722Cit 和 0722Arg 抗体的平均水平显著降低。所有既抗 0401Cit 又抗 0722Cit 的患者治疗后转为阴性。抗 0401Cit/Arg 和抗 0722Cit/Arg 的存在与 HIV 的存在显著相关。
ACPA 可能存在于 TB 患者中。在大多数情况下，反应性与瓜氨酸无关。因此，在这些患者中，循环瓜氨酸化肽（CCP）检测阳性应谨慎解释，并最好通过非瓜氨酸化抗原的对照 ELISA 进行随访。
