Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
J Clin Rheumatol. 2012 Mar;18(2):67-70. doi: 10.1097/RHU.0b013e318247caf0.
Patients with infective endocarditis (IE) may present rheumatic manifestations concurrent with autoantibodies with low specificity, thus increasing misdiagnosis. Frequency of autoantibodies with high specificity remains unknown.
Nineteen patients with definite IE were studied for low specificity (rheumatoid factor [RF], antinuclear antibodies, anti-Ro/SSA, anti-La/SSB, anti-ribonucleoproteins (anti-RNP) anticardiolipin [aCL], and anti-β2 glycoprotein 1) and high specificity (anti-cyclic citrullinated peptides [anti-CCPs], anti-double-stranded DNA, anti-Sm, anti-Scl70, and anticentromere) antibodies.
Frequency of RF was 68%; antinuclear antibodies, 47%; aCL/IgG, 58%; aCL/IgM, 47%; anti-β2 glycoprotein 1/IgG, 5%; and anti-Ro/SSA, 5%. Three patients had antiphospholipid syndrome-related antibodies in high titers, one of them also having pulmonary embolism. Except for anti-CCP (1 patient), other highly specific antibodies were absent.Rheumatoid factor of 100 UI/mL or greater and multifocal endocarditis were independently associated with in-hospital mortality.
Clinicians should need to be aware about the common presence of a variety of antibodies with low specificity but also the exceptional occurrence of anti-CCP antibodies in IE. Special attention to multifocal endocarditis and high RF is also suggested.
感染性心内膜炎（IE）患者可能同时出现风湿表现和特异性低的自身抗体，从而增加误诊。高特异性自身抗体的频率尚不清楚。
对 19 例明确 IE 患者进行低特异性（类风湿因子[RF]、抗核抗体、抗 Ro/SSA、抗 La/SSB、抗核糖核蛋白[抗 RNP]、抗心磷脂[aCL]和抗β2 糖蛋白 1）和高特异性（抗环瓜氨酸肽[抗 CCPs]、抗双链 DNA、抗 Sm、抗 Scl70 和抗着丝点）抗体检测。
RF 频率为 68%；核抗体为 47%；aCL/IgG 为 58%；aCL/IgM 为 47%；抗β2 糖蛋白 1/IgG 为 5%；抗 Ro/SSA 为 5%。3 例患者高滴度抗磷脂抗体谱相关抗体，其中 1 例合并肺栓塞。除抗 CCP（1 例）外，其他高特异性抗体均未见。100 UI/mL 或更高的 RF 和多灶性心内膜炎与住院死亡率独立相关。
临床医生应注意到 IE 患者常出现多种特异性低的抗体，但也可能出现抗 CCP 抗体。还应特别注意多灶性心内膜炎和高 RF。
