Proven Anne, Bartlett Rachelina P, Moder Kevin G, Chang-Miller April, Cardel Laynalee K, Heit John A, Homburger Henry A, Petterson Tanya M, Christianson Teresa J H, Nichols William L
Division of Rheumatology and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2004 Apr;79(4):467-75. doi: 10.4065/79.4.467.
To assess the performance of 4 clotting assays for lupus anticoagulant (LA) detection, to determine the prevalence of LA and anticardiolipin antibodies (aCL), and to correlate LA and aCL prevalence with systemic disease and thrombosis.
We studied 664 consecutive patients at the Mayo Clinic in Rochester, Minn, who were referred for laboratory testing because of a clinical suspicion of LA or thrombophilia between June 25, 1990, and July 1, 1991.
Of 664 patients tested for LA, 584 also were tested for aCL. Of patients tested for both LA and aCL, 137 (235%) had positive results for one or both tests (13 [95%], LA-positive only; 76 [555%], aCL-positive only; and 48 [35.0%], positive for both). The dilute Russell viper venom time (DRVVT) was the most frequently positive LA assay (74% of the 61 patients with positive results for LA). Twenty-two patients (36.1% of the 61) had positive results for all 4 LA assays, whereas 21 (34.4% of the 61) had positive results for only 1 LA assay: activated partial thromboplastin time (3 patients [4.9%]), plasma clot time (5 patients [8.2%]), kaolin clot time (5 patients [8.2%]), or DRVVT (8 patients [13.1%]). Thromboembolism prevalence was not definitely associated with positive test results (LA only, aCL only, or LA plus aCL), nor was it strongly associated with aCL isotype or titer. Furthermore, thromboembolism prevalence was not increased when all LA assays were positive, although a history of deep venous thrombosis or pulmonary embolism was nonsignificantly associated with positive results for all 4 LA tests. The likelihood of having both LA- and aCL-positive test results was higher among patients with systemic lupus erythematosus (26 [19.0%] of 137 patients with positive results for one or both tests), but they had no more thrombotic events or fetal loss than other patients in our study group.
The DRVVT identified more patients with LA than the other LA tests, but more than 1 LA test was required to identify all patients with LA. Positive results were much more common for aCL than for LA. No single LA test or anticardiolipin isotype correlated with thrombosis or systemic disease in this population.
评估4种凝血检测方法对狼疮抗凝物（LA）检测的性能，确定LA和抗心磷脂抗体（aCL）的患病率，并将LA和aCL患病率与系统性疾病及血栓形成相关联。
我们研究了明尼苏达州罗切斯特市梅奥诊所连续收治的664例患者，这些患者因临床怀疑存在LA或血栓形成倾向于1990年6月25日至1991年7月1日期间被转诊进行实验室检测。
在664例接受LA检测的患者中，584例同时接受了aCL检测。在接受LA和aCL检测的患者中，137例（23.5%）一项或两项检测结果为阳性（仅LA阳性13例[9.5%]；仅aCL阳性76例[55.5%]；两项均阳性48例[35.0%]）。稀释蝰蛇毒时间（DRVVT）是最常出现阳性结果的LA检测方法（61例LA检测阳性患者中的74%）。22例患者（61例中的36.1%）4种LA检测均为阳性，而21例患者（61例中的34.4%）仅1种LA检测为阳性：活化部分凝血活酶时间（3例患者[4.9%]）、血浆凝固时间（5例患者[8.2%]）、高岭土凝固时间（5例患者[8.2%]）或DRVVT（8例患者[13.1%]）。血栓栓塞患病率与检测结果阳性（仅LA阳性、仅aCL阳性或LA加aCL阳性）无明确关联，也与aCL亚型或滴度无强关联。此外，当所有LA检测均为阳性时，血栓栓塞患病率并未增加，尽管深静脉血栓形成或肺栓塞病史与所有4种LA检测结果阳性之间存在非显著关联。在系统性红斑狼疮患者中，LA和aCL检测结果均为阳性的可能性更高（137例一项或两项检测结果为阳性的患者中有26例[19.0%]），但在我们的研究组中，他们发生血栓事件或胎儿丢失的情况并不比其他患者多。
与其他LA检测方法相比，DRVVT检测出的LA患者更多，但需要不止1种LA检测才能识别所有LA患者。aCL检测结果阳性比LA检测结果阳性更为常见。在该人群中，没有单一的LA检测或抗心磷脂亚型与血栓形成或系统性疾病相关。
