Magy N, Gil H, Racadot E, Dupond J L
Service de médecine interne et immunologie clinique, CHU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France.
Rev Med Interne. 2002 Aug;23(8):696-702. doi: 10.1016/s0248-8663(02)00644-6.
The value of antiphospholipid antibodies (aPL) detected in the sera of the patients of an Internal Medicine department is not univocal and is still much debated. To test the contribution of such new markers, we reviewed the records of patients having antiphospholipid antibodies detected between 1996 and 1997.
One hundred and twenty four patients, having at least one of these two aPL: lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or one of these two anti-proteins: anti-beta 2glycoprotéin I antibodies (anti-beta 2GPI) or anti-prothrombin antibodies (aPT), were studied. LA was detected by a PTT-LA technique and aCL, anti-beta 2GPI and aPT by ELISA-sandwich techniques. For each patient we recorded sex, age, personal and familial history of thrombosis, fetal losses and systemic disease, the reason of aPL detection, the final diagnosis, activated partial thromboplastin time (aPTT), platelets count and type of aPL.
The population was composed of 77 women (62%) and 47 men (38%) with a mean age of 54 years [12-92 years]. A thrombocytopenia was strongly correlated to aCL presence (OR = 6.15 et p = 0.03). The reason of aPL detection was venous thrombosis, recurrent fetal losses, systemic disease, infectious disease or fortuitous discovery of a prolonged aPTT. The final diagnosis was a systemic disease in 57% of cases, an infectious disease in 14.5%, a thrombosis in 4.5% and a neoplasia in 3%. LA was detected in 54% of patients, aCL in 39.5%, anti-beta 2GPI in 23% and aPT in 31%. No relationship between the aPTT value and the type of aPL could be established.
Our study shows that familial histories of venous thrombosis or systemic disease are useful to enhance antiphospholipid antibodies detection; that LA is mostly associated to systemic and infectious diseases; that aCL and anti-beta 2GPI are predominant in case of venous thrombosis and that thrombocytopenia has to enhance aCL detection and the discussion about a possible APS.
在内科患者血清中检测到的抗磷脂抗体（aPL）的价值并不明确，仍存在诸多争议。为了检验这些新标志物的作用，我们回顾了1996年至1997年间检测出抗磷脂抗体的患者记录。
研究了124例患者，这些患者至少有以下两种aPL中的一种：狼疮抗凝物（LA）、抗心磷脂抗体（aCL），或者以下两种抗蛋白中的一种：抗β2糖蛋白I抗体（抗β2GPI）或抗凝血酶原抗体（aPT）。LA通过PTT-LA技术检测，aCL、抗β2GPI和aPT通过酶联免疫吸附双抗体夹心法检测。对于每位患者，我们记录了性别、年龄、个人及家族血栓形成史、胎儿丢失情况和全身性疾病、aPL检测原因、最终诊断、活化部分凝血活酶时间（aPTT）、血小板计数以及aPL类型。
该人群由77名女性（62%）和47名男性（38%）组成，平均年龄为54岁[12 - 92岁]。血小板减少与aCL的存在密切相关（比值比 = 6.15，p = 0.03）。aPL检测的原因是静脉血栓形成、反复胎儿丢失、全身性疾病、感染性疾病或偶然发现aPTT延长。最终诊断为全身性疾病的占57%，感染性疾病占14.5%，血栓形成占4.5%，肿瘤占3%。54%的患者检测出LA，39.5%检测出aCL，23%检测出抗β2GPI，31%检测出aPT。无法确定aPTT值与aPL类型之间的关系。
我们的研究表明，静脉血栓形成或全身性疾病的家族史有助于提高抗磷脂抗体的检测；LA大多与全身性疾病和感染性疾病相关；静脉血栓形成时aCL和抗β2GPI占主导地位，血小板减少会增加aCL的检测以及关于可能的抗磷脂综合征（APS）的讨论。
