Evidence for locally synthesized and clonally restricted immunoglobulin in the synovial fluid from rheumatoid arthritis patients

In this study, we examined the immunoglobulin (Ig) present in synovial fluid (SF) from patients with rheumatoid arthritis (RA) to determine if it was locally produced and to assess the presence of clonally restricted (oligoclonal) immunoglobulin. We studied SF/serum pairs from 55 RA patients and 23 patients with degenerative joint disease (DJD). We found increases in total protein, IgG, IgA, and IgM in RA vs DJD SF (P less than 0.01). The immunoglobulin present in RA appeared to be locally produced as evidenced by significant increases (P less than 0.01) in the immunoglobulin indices. Regression analysis among the levels of IgG, IgA, and IgM RF and the Ig indices suggested that only a minority of the locally synthesized Ig present was specific for RF. To provide evidence of clonal restriction, we further analyzed the SF specimens by isoelectric focusing and assessed the presence of oligoclonal bands present only in RA SF. In 7/55 RA specimens (13%) we found unique SF IgG bands. All bands were of similar isoelectric point (pI), being quite cathodic with pI greater than 7.5. Our evidence supports synthesis of Ig within RA synovium, with a minority of patients showing prominent and unique SF Ig bands. This suggests an oligoclonal response in SF of some patients, but polyclonal Ig synthesis in most.     

Effect of Rheumatoid Factor on Complement-Mediated Phagocytosis

The frequency and amount of IgM rheumatoid factor (RF) in the blood of patients with rheumatoid arthritis (RA) correlate with the severity of the disease and the number of complications. Though previous studies of RF in subacute bacterial endocarditis have shown that RF inhibits phagocytosis of microorganisms by granulocytes, the presence of low levels of complement (C) in blood and synovial fluid of patients with the highest titers of RF suggests that an interaction between RF and C may contribute to the inflammatory process in RA. We thus employed a quantitative methodology to examine the effect of RF on complement-dependent phagocytosis of sheep erythrocytes by rabbit granulocytes. Addition of 2500 molecules of IgM RF to sheep cells heavily coated with IgG antibody (195,000 molecules per cell) resulted in virtually complete inhibition of uptake of C3 (beta(1c)) and prevention of phagocytosis, an effect resulting from inhibition of uptake of C1 by the cells. When erythrocytes coated with only 34,000 molecules of IgG antibody were employed, phagocytosis was similarly inhibited. However the effect of RF on such cells was shown to be primarily mediated through inhibition of C4 rather than C1 uptake. Although the results do not exclude the participation of an IgM RF of higher avidity, present only in the tissues in rheumatoid inflammation, circulating IgM RF probably does not play a potentiating role in rheumatoid inflammation.     

类风湿关节炎患者血清IgG及亚类的水平和临床意义

目的探讨类风湿关节炎(RA)患者血清IgG及亚类的水平和临床意义。方法选择2018年10月至2019年6月该院风湿免疫科收治的RA患者54例纳入RA组,选择同期36例健康体检者纳入对照组。采用双抗体夹心法ELISA检测血清IgG亚类水平;采用免疫散射比浊法检测免疫球蛋白(IgG、IgA、IgM)、补体(C3、C4)和类风湿因子(RF)水平;采用流式点阵免疫发光法检测抗环瓜氨酸肽(CCP)抗体水平。比较两组各检测指标水平,分析RA患者血清IgG亚类与IgG、IgA、IgM、C3、C4、RF及抗CCP抗体之间的相关性。结果RA组血清IgG、IgA、RF和抗CCP抗体水平显著高于对照组(P<0.05),但IgM、C3和C4水平差异无统计学意义(P>0.05)。RA组血清IgG1和IgG3水平显著高于对照组(P<0.05),两组血清IgG2和IgG4水平差异无统计学意义(P>0.05)。与对照组比较,RA组IgG1/IgG和IgG3/IgG显著升高(P<0.05),而IgG2/IgG显著下降(P<0.05)。Spearman相关分析显示,RA组患者血清IgG1水平与IgG呈高度正相关(r=0.865,P<0.05);IgG2、IgG3水平与IgG均呈中度正相关(r=0.613、0.644,P<0.05);IgG4水平与IgG呈低度正相关(r=0.271,P<0.05);IgG2水平与IgA呈低度正相关(r=0.399,P<0.05);IgG3水平与IgM呈低度正相关(r=0.343,P<0.05)。IgG各亚类与RF、抗CCP抗体之间均无相关性(P>0.05)。结论RA患者血清IgG水平显著升高,并且存在IgG亚类水平变化。IgG亚类检测对RA早期诊断价值有限。     

Response of patients with IgM and IgA-associated peripheral polyneuropathies to "off-line" immunoadsorption treatment using the Prosorba protein A column

Sensory or sensorimotor demyelinating polyneuropathies may be associated with monoclonal immunoglobulins (paraproteins). Our prior experience suggests that "off-line" Prosorba(R) column treatments may be effective therapy for patients with polyneuropathies associated with paraproteins of the IgG class. We report herein the treatment, using Prosorba(R), of 2 patients with peripheral neuropathies and paraproteins of the IgM class and 1 patient with peripheral neuropathy whose paraprotein was of the IgA class. All three patients were treated "off-line" with Prosorba(R) six times in a 2-week period. Each time they were phlebotomized 1 U of whole blood. The plasma and red cells were separated in the blood bank. The plasma was passed over the column while the red blood cells were returned to the patient through a heparin lock. Then the treated plasma was returned separately. There were no adverse effects of treatment, and, in one patient with an IgM paraprotein and one with an IgA paraprotein, neurological symptoms and signs improved over the subsequent 2 weeks. Prosorba(R) appears effective for predominantly sensory demyelinating polyneuropathies associated with M-components of all major immunoglobulin classes. Our current experience further suggests that the mechanism of action of Prosorba(R) may not depend on removal of small amounts of IgG-containing immune complexes from patients' plasma. A proper large-scale clinical trial is warranted.     

IgM, IgG, and IgA rheumatoid factors in pigeon hypersensitivity pneumonitis

The association of rheumatoid factor (RF) and lung disease in several immunologically mediated conditions has suggested that it may be physiopathologically relevant. Since previous reports in hypersensitivity pneumonitis (HP) have dealt mainly with the immunoglobulin M (IgM) RF measurement, we studied such antibody activity in other immunoglobulins, to determine the IgG and IgA RF levels in pigeon-HP, and in asymptomatic breeders (AB) and rheumatoid arthritis (RA) as controls. RFs were measured in 35 HP patients, 41 AB, 31 RA controls, and 55 healthy donors by enzyme-linked immunosorbent assay (ELISA) using human or rabbit immunoglobulin G (IgG), anti-IgM, F(ab')2 of IgG, and IgA F(ab')2 conjugates. An affinity chromatography, fragment crystallizable (Fc) preparations of IgG, pepsin digestion, and Western blots were used to confirm RF specificity. We also evaluated anti-avian antibodies (AA) and cross-reacting antibodies. The HP group revealed positive IgM (51.4%), IgG (31.4%), and immunoglobulin A (IgA) (34.2%) RF tests, and these antibody values exceeded the AB reference levels (P<0.02). HP and RA showed a similar frequency and distribution of RFs. Possible immunoassay interferences were excluded. As in other immunologically mediated diseases, IgG and IgA RFs may play a pathogenic role in HP, amplifying the inflammatory reaction, immune-complex formation, and complement activation. IgM-RF producing cells that have been implicated in the presentation of self and foreign antigens, and T-cell activation might induce the isotype switching of RFs.     

Interaction of immunoglobulins with liposomes

Liposomes were used as model targets to test the effect of immunoglobulins on biomembranes. Heat-aggregated immunoglobulins (Ig) exceeded native immunoglobulins in their capacity to release anions and glucose from model liposomes (either lecithin-dicetyl-phosphate-cholesterol or lecithin-stearylamine-cholesterol in molar ratios of 7:2:1). This interaction was not dependent upon the presence of cholesterol in the membrane. Mild heat-aggregation (10 min at 61.5 degrees C) increased the membrane-perturbing activity of certain Ig. Activity varied among classes and subclasses: IgG1 > pooled IgG > IgG4 > IgA1 > IgG3. IgG2, IgA2 and IgM were inert. Fc fragments of IgG were as active as IgG1, whereas Fab fragments were inactive. Prolonging aggregation to 60 min destroyed the activity of Ig. Membrane-activity could not be induced in non-Ig molecules (such as bovine serum albumin) by 10 or 60 min heat-aggregation. Density gradient centrifugation of IgG1 molecules indicated that membrane perturbing activity was associated with 15-20-s aggregates. Sepharose 4B chromatography demonstrated preferential interaction between cationic membranes and aggregated Ig, whereas anionic membranes interacted nonselectively with both native and aggregated Ig via salt-like interactions. One explanation for these data is that heat aggregation induces a conformational change in the Fc regions of certain Ig permitting them to interact with liposomes, presumably by enhancing their hydrophobic associations with membrane phospholipids.     

A randomized double-blind sham-controlled trial of the Prosorba column for treatment of refractory rheumatoid arthritis.

The Prosorba column has been studied as a novel therapy for rheumatoid arthritis in several clinical settings over the last 5 years. In this article, we summarize the pivotal clinical trial study supporting the safety and efficacy of the Prosorba column as it is applied to treatment of rheumatoid arthritis. The Prosorba column is a medical device that contains purified staphylococcal protein A covalently bound to a silica matrix. This device is used to treat patient plasma in conjunction with a plasmapheresis machine. In this ex vivo treatment, blood is withdrawn from the patient, cells are separated from plasma in the machine, and the plasma is passed through the Prosorba column. The plasma then is recombined with the cells and returned to the patient. The Prosorba column was approved for the treatment of idiopathic thrombocytopenic purpura in 1987 and, in 2 open-label trials (1,2), showed promising evidence of efficacy in rheumatoid arthritis. A subsequent Phase 3 pivotal trial demonstrated statistical superiority of Prosorba treatments to sham column apheresis (3). Analysis of the pivotal trial of patients who completed all treatments indicated that 41.7% of the Prosorba treated patients met American College of Rheumatology defined response criteria as compared to 15.6% of the sham treated patients. This difference was significant at a level of p < or = 0.02.     

类风湿关节炎患者外周血CD4~+CD25~+CD127~(lo)调节性T细胞的变化及意义

目的探讨类风湿关节炎(RA)患者外周血CD4+CD25+CD127loTreg调节性T细胞(Treg)的变化及意义。方法采用流式细胞术检测30例活动期RA患者和15例健康志愿者外周血中CD4+CD25+CD127lo调节性T细胞的数量及其在CD4+T淋巴细胞中所占的比例,并研究其与RA患者疾病活动度指标(DAS28评分)、血沉(ESR)、C反应蛋白(CRP)、类风湿因子(RF)以及其他相关性指标如免疫球蛋白(IgG、IgA、IgM)、补体(C3、C4)、红细胞(RBC)、血小板(PLT)、血红蛋白(HGB)、血清铁(SI)之间的关系。结果RA活动期患者外周血CD4+CD25+CD127loTreg数量低于健康志愿者,活动期患者CD4+CD25+CD127loTreg占CD4+T淋巴细胞的百分比为(2.75±1.01)%,明显低于健康志愿者(4.18±0.89)%(P<0.01)。RA活动期患者CD4+CD25+CD127loTreg表达水平与DAS28评分、ESR、CRP、免疫球蛋白(IgG、IgA)、PLT呈负相关(P<0.05),与血红蛋白(HGB)、血清铁(SI)、及补体(C3、C4)呈正相关(P<0.05),而与RF、RBC、IgM无明显相关性(P>0.05)。结论CD4+CD25+CD127loTreg细胞参与了RA的发病和疾病的活动,同时也可能为RA引起贫血的原因之一。     

Antibodies to cyclic citrullinized peptide in rheumatoid arthritis

AIM: To estimate a diagnostic value of antibodies to cyclic citrullinized peptide (CCP) in rheumatoid arthritis (RA). MATERIAL AND METHODS: The study was made of 85 RA patients. Of them, 48 patients had early RA, i.e. of 8 month and less duration. The control group consisted of 35 patients with non-differentiated arthritis (NDA) and 8 healthy donors. Concentrations of CCP antibodies, rheumatoid factor (RF) IgM and RF IgA were measured with enzyme immunoassay (EIA). RESULTS: The level of CCP antibodies in RA patients (76.3 +/- 43.8; median 100.0 U/ml) was significantly higher than in NDA patients (25.1 +/- 43.9; median 0.8 U/ml; p < 0.05) or in donors (0.38 +/- 0.36; median 0.2 U/ml; p < 0.05). A correlation was found between the CCP antibodies level and that of RF IgM (chi2 = 15.4; p = 0.001) and RF IgA (chi2 = 10.3; p = 0.001). Sensitivity (82%) and specificity (90%) of CCP antibodies in RA diagnosis was higher than these parameters for RF IgM and IgA (78%, 86% and 72%, 83%, respectively). Simultaneous tests for CCP antibodies, RF IgM and RF IgA led to a 93% specificity. CCP antibodies were detected in 50% patients seronegative by RF IgM and in 62% patients seronegative by IgA. Detection of CCP antibodies was closely associated with early RA (chi2 = 30.8; p = 0.0001). CONCLUSION: The EIA for CCP antibodies is a sensitive and specific serological test for early RA diagnosis.     

Anti-cyclic citrullinated peptide autoantibodies in IgM rheumatoid factor-positive patients

BACKGROUND: Antibodies to citrullinated proteins have been described in patients with RA and these appear to be the most specific markers of the disease. The objective of this study was to analyse the improvement in diagnostic accuracy of anti-cyclic citrullinated peptide autoantibodies and IgA rheumatoid factor in patients with clinical suspicion of RA and who were IgM rheumatoid factor-positive. Anti-CCP antibodies were measured with three different second-generation enzyme immunoassays. METHODS: We chose 133 serum samples with IgM RF levels greater than 20 IU/mL sent to our Laboratory from Specialized Care Units. Subsequently, patients were classified according to their clinical records. Eighty-seven had rheumatoid arthritis and 46 had other diseases. In all samples anti-CCP and IgA RF were measured by the corresponding ELISAs. RESULTS: Comparison of the three anti-CCP second-generation ELISAs revealed differences between them. Likewise, clinical performances in terms of sensitivity, specificity, and positive and negative likelihood ratios were different. In patients with IgM RF higher than 20 IU/mL, anti-CCP antibodies increased the clinical efficiency of IgM RF and offered better performance as compared with IgA RF. CONCLUSIONS: The use of anti-CCP antibodies affords good clinical efficiency and modifies the pre-test probability of the occurrence of RA in patients with IgM rheumatoid factor higher than 20 IU/mL.     

19S IgM rheumatoid factor-7S IgG rheumatoid factor immune complexes isolated in patients with rheumatoid arthritis

Sera of 12 patients with rheumatoid arthritis (RA) who had positive IgM-rheumatoid factor (RF) tests were separated by use of immunoabsorbent columns (goat anti-human C3 [alpha HC3] and rabbit anti-human C1q [alpha HC1q]) and polyethylene glycol (PEG) precipitation-protein A affinity chromatography to isolate their immune complexes (IC). The isolated fractions were assayed for 19S IgM RF and 7S IgG RF by enzyme-linked immunosorbent assay (ELISA). The sera were further analyzed by preparative isoelectric focusing (IEF). The alpha HC1q and alpha HC3 columns were sequentially eluted with barbital buffer, 0.02 mol/L EDTA, 0.5 mol/L NaCl, and 1 mol/L propionic acid. All 12 patients had IgM RF and IgG RF in the EDTA fractions from both immunoabsorbent columns, but only IgM RF in the NaCl fractions. The PEG precipitation-protein A preparations were eluted with 0.5 mol/L glycine HCl and 3.5 mol/L MgCl2. All 12 patients had significant titers of 19S IgM RF (greater than or equal to 1:192) and 7S IgG RF (greater than or equal to 1:96) in the acid-eluted fraction. Analysis of the sera by preparative IEF revealed IgM RF with a polyclonal spectrotype pattern with pH of 3.0 to 10.0, but predominantly acidic proteins with isoelectric points of 4.0 to 5.5 IgG RF were found in the same restricted spectrotypic pattern. These studies demonstrated that IC can be detected in the sera of patients with RA by isolation with alpha HC1q and alpha HC3 immunoabsorbent columns and PEG precipitation-protein A affinity chromatography.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cryoimmunoglobulinemia in rheumatoid arthritis. Significance in serum of patients with rheumatoid vasculitis.

Cryogloculins were examined in a standardized manner in an unselected group of 35 patients with rheumatoid arthritis (RA) and 8 patients with RA complicated by cutaneous vasuclitis and neuropathy. Optimum conditions for detection and characterization of cryoglobulins were established; the proportion of resolubilized to total precipitable protein remained constant in an individual patient under these conditions. All 8 vascultis patients and 9 of 35 other patients with RA exhibited cryoglobulins; total protein and immunoglobin content were significantly higher in the cryoglobulins of patients with vasculitis. Immunoglobulins G and M constituted two-thirds and three-quarters of the total protein in the cryoglobulins from uncomplicated rheumatoid and vasculitis patients, respectively. Serum antiglobulin titers were higher, and serum C3 levels were lower, in vasculitis patients compared to rheumatoid patients without vasclitis. Anti-gamma globulin activity was detected in all cryoglobulins from vasculitis patients. Cryoglobulin IgG and IgM were polyclonal. Density gradient analyses demonstrated the majority of the cryoglobulin activity to reside in the 19S IgM fraction. There was no evidence of a light weight (8S) IgM. A monoclonal rheumatoid factor did not detect 7S-ANTI-7S complexes in the cryoprecipitates, but acid eluates from some cryoglobulins absorbed with insoluble IgG revealed an antiglobulin of the IgG class. Serial studies performed on vasculitis patients treated with cyclophosphamide disclosed a relationship between clinical evidence of vasculitis and the presence of cryoglobulins. The antigen (IgG) and antibody (largely IgM rheumatoid factor) nature of these cryglobulins is presented as evidence that the widespread vascular complications of RA are mediated, at least in part, by circulating immune complexes.     

Monomeric (7S) IgM found in the serum of rheumatoid arthritis patients share idiotypes with pentameric (19S) monoclonal rheumatoid factors

Serum from some seropositive (RF+) rheumatoid arthritis (RA) patients contains relatively high concentrations of monomeric (7S) IgM molecules. Seven S IgM molecules fail to bind the Fc portion of IgG, unlike 19S IgM RFs that bind aggregated IgG in classical RF assays. Some pentameric IgM RFs are marked by crossreactive idiotypes (RCRI) defined by prototypic monoclonal RFs. In previous studies, we observed that a proportion of pokeweed mitogen (PWM) induced plasma cells from RA patients' blood lymphocytes express the major RCRI as assayed by indirect immunofluorescence with polyclonal anti-RCRI antibodies. In this study, 7S IgM obtained from three different RF+ RA patients inhibits specific anti-RCRI intracytoplasmic staining of PWM induced RF+ RA-derived plasma cells. These 7S molecules also block polyclonal anti-RCRI antibodies from reacting with red blood cells bearing 7S IgM molecules from RF+ patients with RA or Waldenstrom's macroglobulinemia. We conclude that some 7S IgM molecules in the serum of RF+ RA patients are marked by the major RCRI idiotype and are related to 19S monoclonal and polyclonal RFs.     

Monoreactive high affinity and polyreactive low affinity rheumatoid factors are produced by CD5+ B cells from patients with rheumatoid arthritis

In patients with rheumatoid arthritis (RA), circulating CD5+ B lymphocytes, but not CD5- B lymphocytes, are increased in number and size, exist in an activated state, spontaneously proliferate, and secrete Ig that binds to the Fc fragment of IgG. By constructing continuous mAb-secreting cell lines from CD5+ B lymphocytes, the properties and dissociation constants (Kd) of these antibodies were determined. Two types of rheumatoid factors (RFs) with discrete reactivities were produced. The first type is polyreactive and binds with relatively low affinity (Kd, 10(-5) mol/liter) to the Fc fragment of IgG. These antibodies are similar to those produced by CD5+ B cells from healthy subjects. The second type of RF is monoreactive and binds with higher affinity (Kd, 10(-7) mol/liter) to the Fc fragment of IgG. These latter autoantibodies are produced by CD5+ B cells of RA patients, but not healthy subjects. Long-term longitudinal studies are needed to determine the role of these two types of RFs in the pathogenesis of RA.     

Defining the genetic origins of three rheumatoid synovium-derived IgG rheumatoid factors.

A major diagnostic marker in most rheumatoid arthritis (RA) patients is the rheumatoid factor (RF), an autoantibody that binds to the Fc region of IgG. To delineate the Ig genes and the underlying mechanism for RF production in RA patients, we applied a systematic approach to define the genetic origins of three IgG RFs derived from the synovial fluid of two RA patients. The results show that two of three IgG RF have substantial numbers of somatic mutations in their variable (V) regions, ranging from 13 to 23 mutations over a stretch of 291-313 nucleotides, resulting in a frequency of 4.4-7.8%. However, one IgG RF has only one mutation in each V region. This result indicates that an IgG RF may arise from a germline gene by very few mutations. The mutations occur mainly in the complementarity-determining regions (CDRs), and the mutations in the CDRs often lead to amino acid substitutions. Five of the six corresponding germline V genes have been found to encode either natural autoantibodies or autoantibodies in other autoimmune disorders; and three of the six V genes have been found in fetal liver. Taken together with other results, the data show that (a) several potentially pathogenic RFs in RA patients arise from natural autoantibodies, and (b) only a few mutations are required to convert the natural autoantibodies to IgG RFs.     

系统性红斑狼疮和类风湿性关节炎患者外周循环中APRIL表达水平的检测和意义

目的探讨增殖诱导配体（APRIL）在系统性红斑狼疮（SLE）和类风湿性关节炎（RA）中的表达情况及其与B细胞刺激因子（BLyS）、抗双链DNA抗体（抗dsDNA）及疾病预后的相关性。方法用逆转录-实时定量聚合酶链反应（PCR）检测19例SLE和39例RA患者及20名健康对照者的外周血单个核细胞（PBMC）中A-PRIL和BLyS mRNA的表达，用酶联免疫吸附试验（ELISA）检测血清中APRIL和BLyS蛋白水平。同时，检测血清IgG、IgA、IgM、类风湿因子（RF）和抗dsDNA水平。结果SLE和RA患者未缓解组较对照组、疾病初发组和治疗后缓解组APRIL mRNA水平显著升高，与BLyS mRNA表达水平呈中等程度的相关性。疾病组外周循环中BLyS蛋白显著升高，APRIL蛋白未见升高，APRIL与BLyS无相关性，APRIL蛋白与抗dsDNA和疾病活动度之间无相关性。结论检测APRIL mRNA含量在判断自身免疫病患者病情和疾病预后中有一定价值。     

联合检测抗环瓜氨酸肽抗体与抗角蛋白抗体对RA诊断意义

目的联合检测抗CCP抗体和AKA，评价血清学临床诊断意义。方法对320例有症状性关节痛或关节炎的患者，ELISA法检测抗CCP IgG抗体，间接免疫荧光法检测AKA，ELISA法检测RF IgA、IgG、IgM。结果抗CCP抗体、AKA、RF的阳性率分别为25．9％（83／320）、30．3％（97／320）、43．4％（139／320），30例正常对照中，仅2例RF阳性，1例CCP阳性，其余指标均为阴性。三种抗体同时阳性率23．8％（76／320），明显高于正常对照组（P〈0．01）。结论抗CCP抗体和AKA并同时检测RF IgA、IgG、IgM。有助于诊断和早期诊断。并可作为临床治疗动态观察指标。     

免疫球蛋白及血细胞在肝肾不足、风湿阻络型尪痹中的表达

目的:探讨免疫球蛋白和血细胞与肝肾不足、风湿阻络型类风湿性关节炎(尪痹)的相关性?椒ǎ?随机选择符合要求的病例30例,测定免疫球蛋白和血细胞的值,并对所测结果进行统计学分析。结果:肝肾不足、风湿阻络型尪痹的免疫球蛋白中IgG、IgM、IgA显著升高(P<0.01),血细胞中HGB、PLT显著下降(P<0.01),WBC、C3无改变(P>0.05)。结论:IgG、IgM、IgA升高,HGB、PLT降低对肝肾不足、风湿阻络型尪痹有诊断意义,RBC对其诊断有参考意义,WBC、C3无诊断学意义。     

Rheumatoid factor quantitation: a comparison of ELISA and nephelometric methods

Quantitation of rheumatoid factors (RF) by nephelometry, and more recently by enzyme linked immunosorbent assay (ELISA), are achieving increasingly common usage. Sera from 101 rheumatoid patients were compared by both methods and screened by a latex fixation method. Good correlation was found between the two assay techniques, the ELISA showing greater sensitivity and measuring IgG RF and IgA RF in addition to IgM RF. Both assay methods were reliable, accurate, rapid and sensitive for routine clinical purposes.     

类风湿关节炎患者红细胞CD35的表达及其意义

目的　研究红细胞Ⅰ型补体受体 (CD3 5)在类风湿关节炎 (rheumaoidarthritis,RA)患者血液中的表达水平及其影响因素 ,探讨红细胞CD3 5在RA发病过程中的意义。方法　采用流式细胞术 (FCM)测定 37例RA患者 (其中早期 12例、中晚期 2 5例 )和 12名健康对照者血液中红细胞CD3 5的表达水平 ,并同期测定RA患者的相关实验室指标 (IgG、IgA、IgM、C3、C4、RF、α 1 AGP、CRP、ESR、RBC等 ) ,分析各指标之间的关系。结果　37例RA患者红细胞CD3 5的表达水平为 (16 .6 7± 13.2 1) % ,健康对照组为 (2 9.94± 2 3.5 3) % ,两组比较差异有显著性意义 (P =0 .0 17)。早期与中晚期RA患者红细胞CD3 5表达水平分别为 (14 .38± 9.96 ) %、(17.76± 14 .5 7) % ,两组的差异无统计学意义 (P >0 .0 5 )。相关分析显示 ,红细胞CD3 5的表达水平与RA患者的RBC计数、RF呈正相关 (r值分别为 0 .30 1、0 .5 5 5 ,P值分别为 0 .0 4 2、0 .0 0 1) ,而与年龄、病程、IgG、IgA、IgM、C3、C4、RF、α 1 AGP、CRP、ESR的相关性无显著意义 (P >0 .0 5 )。结论　类风湿关节炎患者内源性补体活性调节蛋白水平降低是其发病的重要环节之一 ,可作为反映RA病情的一个相对独立的观察指标 ,其机理还有待进一步研究