Lee R M, Branch D W, Silver R M
Department of Obstetrics and Gynecology, University of California at Irvine, Orange, USA.
Am J Obstet Gynecol. 2001 Sep;185(3):748-53. doi: 10.1067/mob.2001.117659.
Studies in rheumatologic populations suggest that immunoglobulin A antiphospholipid antibodies are strongly associated with the clinical manifestations of antiphospholipid syndrome. However, the association between immunoglobulin A antiphospholipid antibodies and pregnancy loss is uncertain. We determined whether immunoglobulin A antiphospholipid antibodies, specifically anti-beta(2)-glycoprotein I and anticardiolipin, are associated with the obstetric features of antiphospholipid syndrome.
Sera from 4 groups of women were studied: (1) 133 women who experienced unexplained recurrent spontaneous abortion, (2) 48 women who experienced unexplained fetal death, (3) 145 healthy fertile control subjects, and (4) 67 women with well-characterized antiphospholipid syndrome. Serum immunoglobulin A, immunoglobulin G, and immunoglobulin M anti-beta(2)-glycoprotein I and anticardiolipin antibodies were determined by enzyme-linked immunoassay.
Groups of women who experienced unexplained recurrent spontaneous abortion and unexplained fetal death had a higher proportion of women who had positive test results for immunoglobulin A anti-beta(2)-glycoprotein I antibodies than fertile control subjects (P < .01, chi-square test); these subjects also had higher levels of autoantibody (P = .001, Kruskal-Wallis). Women who experienced recurrent spontaneous abortion had a higher proportion of women with positive test results for immunoglobulin A anticardiolipin antibodies compared to fertile control subjects (P < .05, chi-square test); this group also had higher levels of autoantibody (P = .0065, Kruskal-Wallis test). Linear regression analysis showed significant correlation between anti-beta(2)-glycoprotein I immunoglobulin A and anti-beta(2)-glycoprotein I immunoglobulin G (R = .609; P =.0001) and less correlation between anticardiolipin immunoglobulin A and anticardiolipin immunoglobulin G (R = .093; P = .065).
Immunoglobulin A anti-beta(2)-glycoprotein I antibodies are more common in women who experience unexplained recurrent spontaneous abortion and unexplained fetal death whose initial test results are negative for lupus anticoagulant and immunoglobulin G anticardiolipin antibodies compared to fertile control subjects. Therefore, these antibodies may identify additional women with clinical features of antiphospholipid syndrome who are not identified through traditional testing. It is unclear whether these antibodies are directly pathogenic, a result of the pregnancy losses, or markers for an underlying, yet uncharacterized autoimmune disorder.
对风湿性疾病人群的研究表明，免疫球蛋白A抗磷脂抗体与抗磷脂综合征的临床表现密切相关。然而，免疫球蛋白A抗磷脂抗体与流产之间的关联尚不确定。我们确定免疫球蛋白A抗磷脂抗体，特别是抗β2糖蛋白I和抗心磷脂抗体，是否与抗磷脂综合征的产科特征相关。
对4组女性的血清进行了研究：（1）133例原因不明的复发性自然流产女性；（2）48例原因不明的胎儿死亡女性；（3）145例健康的可育对照者；（4）67例确诊的抗磷脂综合征女性。采用酶联免疫吸附测定法测定血清免疫球蛋白A、免疫球蛋白G和免疫球蛋白M抗β2糖蛋白I及抗心磷脂抗体。
与可育对照者相比，原因不明的复发性自然流产组和原因不明的胎儿死亡组中，免疫球蛋白A抗β2糖蛋白I抗体检测呈阳性的女性比例更高（P <.01，卡方检验）；这些受试者的自身抗体水平也更高（P =.001，Kruskal-Wallis检验）。与可育对照者相比，复发性自然流产女性中免疫球蛋白A抗心磷脂抗体检测呈阳性的女性比例更高（P <.05，卡方检验）；该组的自身抗体水平也更高（P =.0065，Kruskal-Wallis检验）。线性回归分析显示，抗β2糖蛋白I免疫球蛋白A与抗β2糖蛋白I免疫球蛋白G之间存在显著相关性（R =.609；P =.0001），而抗心磷脂免疫球蛋白A与抗心磷脂免疫球蛋白G之间的相关性较小（R =.093；P =.065）。
与可育对照者相比，原因不明的复发性自然流产和原因不明的胎儿死亡女性中，狼疮抗凝物和免疫球蛋白G抗心磷脂抗体初始检测结果为阴性的情况下，免疫球蛋白A抗β2糖蛋白I抗体更为常见。因此，这些抗体可能识别出更多具有抗磷脂综合征临床特征但通过传统检测未被识别的女性。目前尚不清楚这些抗体是直接致病的，是流产的结果，还是潜在的、尚未明确的自身免疫性疾病的标志物。
