Lin Ko-Ming, Chen Wei-Ming, Tung Shui-Yi, Wei Kuo-Liang, Shen Chein-Heng, Chang Te-Sheng, Chang Pey-Jium
Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Int J Rheum Dis. 2019 Jan;22(1):116-120. doi: 10.1111/1756-185X.13388. Epub 2018 Oct 18.
In order to increase diagnostic sensitivity for early disease in rheumatoid arthritis (RA), new classification criteria were approved in 2010 by the American College of Rheumatology and the European League Against Rheumatism. One of the criteria, a high-positive rheumatoid factor (RF) or anti-citrullinated protein antibody (ACPA) level, was given a high score of 3. However, the increased prevalence of RF in patients with chronic hepatitis C virus (HCV) infection markedly diminishes the diagnostic specificity of serum RF for RA in these patients. There are no published data on the prevalence and predictive value of high-positive RF and ACPA; thus, we investigated high-positive RF and ACPA levels in nonarthritic patients with chronic HCV infection.
Anti-citrullinated protein antibody and total RF were determined in serum from nonarthritic patients with chronic HCV infection (all had HCV RNA viremia).
In 271 HCV-infected patients, positive RF, positive ACPA, high-positive RF, and high-positive ACPA were detectable in 47.2%, 1.1%, 8.9% and 1.1%, respectively. In these patients, fatty liver was an independent factor for high-positive RF.
In contrast to RF, ACPA is not increased in HCV infection. High-positive RF is not unusually present in nonarthritic patients with chronic HCV infection. ACPA may have improved value for the diagnosis of RA in this patient population. In patients with HCV infection, fatty liver may be a risk factor for high-positive RF.
为提高类风湿关节炎（RA）早期疾病的诊断敏感性，美国风湿病学会和欧洲抗风湿病联盟于2010年批准了新的分类标准。其中一项标准，即高滴度类风湿因子（RF）或抗瓜氨酸化蛋白抗体（ACPA）水平，被赋予3分的高分。然而，慢性丙型肝炎病毒（HCV）感染患者中RF患病率的增加显著降低了血清RF对这些患者RA的诊断特异性。目前尚无关于高滴度RF和ACPA的患病率及预测价值的公开数据；因此，我们调查了慢性HCV感染的非关节炎患者中高滴度RF和ACPA水平。
测定慢性HCV感染的非关节炎患者（均有HCV RNA病毒血症）血清中的抗瓜氨酸化蛋白抗体和总RF。
在271例HCV感染患者中，RF阳性、ACPA阳性、高滴度RF和高滴度ACPA的检出率分别为47.2%、1.1%、8.9%和1.1%。在这些患者中，脂肪肝是高滴度RF的独立因素。
与RF不同，HCV感染时ACPA不升高。慢性HCV感染的非关节炎患者中高滴度RF并不常见。ACPA在该患者群体中对RA的诊断可能具有更高的价值。在HCV感染患者中，脂肪肝可能是高滴度RF的一个危险因素。
