Manera C, Franceschini F, Cretti L, Braga S, Cattanec R
Clinical Immunology Unit, Spedali Civili, University of Brescia, Italy.
J Rheumatol. 1994 Nov;21(11):2021-5.
To assess the diagnostic and prognostic power of antiperinuclear factor (APF) and to identify a specific pattern of rheumatoid arthritis (RA) of different evolution and prognosis.
One hundred and fifty-nine sera from patients with RA, 280 sera from patients with other rheumatic diseases and 204 sera from healthy subjects were examined for APF.
Sensitivity and specificity of the test were, respectively, 0.82 and 0.99 when 1:80 serum dilution was considered positive but 0.84 and 0.92 when tested at the currently used 1:5 serum dilution. According to the data obtained from APF and rheumatoid factor (RF) testing, patients with RA were subdivided in 4 groups. Clinical and demographic features for each group were analyzed. RF+ and/or APF+ patients showed a common pattern of disease, whereas RF-/APF- patients showed fewer extraarticular manifestations (p < 0.02) including Sjögren's syndrome (p < 0.04) and an unusual onset of the disease characterized by an involvement of large joints (p < 0.0001). Higher titer of APF was detected at the onset of the disease than in longstanding RA (p < 0.02).
APF is a valuable diagnostic tool and a useful additional marker for RA. 1:80 serum dilution allows more specificity without substantial loss of sensitivity. A specific pattern of RA can be identified on the basis of APF status.
评估抗核周因子（APF）的诊断和预后价值，并确定不同病情演变及预后的类风湿关节炎（RA）的特定模式。
检测了159例RA患者的血清、280例其他风湿性疾病患者的血清以及204例健康受试者的血清中的APF。
当血清稀释度为1:80时检测结果呈阳性，该检测的敏感性和特异性分别为0.82和0.99；而按照目前使用的1:5血清稀释度检测时，敏感性和特异性分别为0.84和0.92。根据APF和类风湿因子（RF）检测获得的数据，将RA患者分为4组。分析了每组的临床和人口统计学特征。RF阳性和/或APF阳性的患者表现出常见的疾病模式，而RF阴性/APF阴性的患者关节外表现较少（p<0.02），包括干燥综合征（p<0.04），且疾病起病不寻常，以大关节受累为特征（p<0.0001）。疾病发作时检测到的APF滴度高于病程较长的RA患者（p<0.02）。
APF是一种有价值的诊断工具，也是RA的一种有用的附加标志物。1:80血清稀释度可提高特异性且不会大幅降低敏感性。可根据APF状态确定RA的特定模式。
