Jaekel H P, Schmid D, Müller E W, Ziutelis V, Trabandt A, Grobe N, Kaskel-Paul S, Höh H, Bauer B, Sudik R, Baldauf A, Werle E
Institute of Laboratory Diagnostics, Microbiology and Transfusion Medicine, Dietrich Bonhoeffer Clinical Centre, Neubrandenburg, Germany.
Clin Lab. 2003;49(7-8):345-55.
To study the antigenic and epitope specificities of anti-phospholipid Ab in detail, we investigated 177 patients without (62 with APS-related systemic clinical symptoms, 115 with microangiopathies) and 164 patients with connective tissue diseases (CTD). Ab associated with primary APS (pAPS) seem to show a restricted specificity (phospholipid/beta2-GPI-complexes), whereas those in secondary APS (sAPS) react additionaly with pure beta2-GPI. Simultaneously, beta2-GPI-independent Ab were also frequently present in both conditions (50% of all Ab-positive sera). In CTD patients, the reactivity profile "pure beta2-GPI + phospholipid/beta2-GPI-complexes" is significantly associated with clinically manifest sAPS. Comparing cardiolipin and phosphatidylserine as antigenic target, the overall concordance (crossreactivity?) between both assays was lower than expected (52%), being highest in pAPS (87%) and sAPS (65%). Based on these results, a two-step procedure for reliable serological diagnosis of APS could be recommended: Ab-screening using a mix of phospholipids complexed with beta2-GPI (sensitivity > 90% for Ab concentrations above 20 U/ml) followed by an assay allowing the simultaneous detection of all relevant antigenic and epitope specificities.
为详细研究抗磷脂抗体的抗原和表位特异性，我们调查了177例无（62例有APS相关系统性临床症状，115例有微血管病变）和164例结缔组织病（CTD）患者。与原发性APS（pAPS）相关的抗体似乎显示出有限的特异性（磷脂/β2 -糖蛋白复合物），而继发性APS（sAPS）中的抗体还与纯β2 -糖蛋白发生反应。同时，在这两种情况下也经常出现不依赖β2 -糖蛋白的抗体（所有抗体阳性血清的50%）。在CTD患者中，“纯β2 -糖蛋白 + 磷脂/β2 -糖蛋白复合物”的反应模式与临床表现的sAPS显著相关。比较心磷脂和磷脂酰丝氨酸作为抗原靶点，两种检测方法之间的总体一致性（交叉反应性？）低于预期（52%），在pAPS中最高（87%），在sAPS中为65%。基于这些结果，可推荐一种用于APS可靠血清学诊断的两步法：使用与β2 -糖蛋白复合的磷脂混合物进行抗体筛查（对于浓度高于20 U/ml的抗体，敏感性>90%），然后进行一种能够同时检测所有相关抗原和表位特异性的检测。
