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用于抗磷脂综合征诊断的抗体谱

Antibody profiles for the diagnosis of antiphospholipid syndrome.

作者信息

Pengo Vittorio, Biasiolo Alessandra, Pegoraro Cinzia, Cucchini Umberto, Noventa Franco, Iliceto Sabino

机构信息

Clinical Cardiology, Thrombosis Center, University of Padova School of Medicine, Ex Busonera Hospital, via Gattamelata 64, 1-35128 Padova, Italy.

出版信息

Thromb Haemost. 2005 Jun;93(6):1147-52. doi: 10.1160/TH04-12-0839.

Abstract

Among the so called 'antiphospholipid antibodies', the presence of Lupus Anticoagulant (LA) is associated with thrombosis-related events and defines the antiphospholipid syndrome. The role of anti-cardiolipin (aCL) antibodies and anti-human beta2-glycoprotein I (abeta2GPI) antibodies is less striking. Since the problem of standardization for these tests is far from resolved, we evaluated whether the combination of results (antiphospholipid laboratory profiles) could help to better classify these patients. Over a 6-year period, 618 consecutive subjects (55% of whom had previous documented thrombosis-related events) were referred to our clinic for Antiphospholipid antibody detection. LA was detected according to internationally accepted recommendations. ACL and abeta2GPI antibodies were detected by Enzyme-Linked-Immunosorbent Assay (ELISA). Patients' records were reviewed for the presence of previous thromboembolic events or obstetric complications according to Sapporo's clinical criteria for the diagnosis of antiphospholipid syndrome (APS) and each patient underwent a physical examination. When individual tests were considered in a multivariate analysis which took into account age, gender, the presence of SLE or other autoimmune diseases and established risk factors for venous and arterial thromboembolism, LA (Odds Ratio 4.4, Confidence Interval 1.5-13.3) and abeta2GPI antibodies (Odds Ratio 2.9, Confidence Interval 1.1-7.5) but not aCL antibodies (Odds Ratio 1.2, Confidence Interval 0.5-2.7) were found to be independent risk factors for thrombosis-related events. When antiphospholipid antibody profiles instead of individual test positivity were analyzed in the above mentioned model, triple positivity resulted a strong independent risk factor (Odds Ratio 33.3, Confidence Interval 7.0-157.6), retaining its significance when the association with venous or arterial thromboembolism was considered. Double positivity with negative LA was close to significance for thrombosis-related events (Odds Ratio 2.2, Confidence Interval 1.0-5.2, p=0.056) and highly significant risk factor for obstetric complications (Odds Ratio 10.8, Confidence Interval 2.9-40.8). Other combinations did not reach statistical significance. The mean level of IgG abeta2GPI antibodies was statistically higher in triple positive profile and might account for positive LA. As compared to a single test, the analysis of a complete antiphospholipid antibody profile can better determine patients at risk.

摘要

在所谓的“抗磷脂抗体”中,狼疮抗凝物(LA)的存在与血栓形成相关事件有关,并可确诊抗磷脂综合征。抗心磷脂(aCL)抗体和抗人β2糖蛋白I(abeta2GPI)抗体的作用则不太显著。由于这些检测的标准化问题远未解决,我们评估了检测结果的组合(抗磷脂实验室指标)是否有助于更好地对这些患者进行分类。在6年期间,618例连续的受试者(其中55%曾有血栓形成相关事件记录)被转至我们诊所进行抗磷脂抗体检测。根据国际公认的推荐方法检测LA。采用酶联免疫吸附测定(ELISA)检测ACL和abeta2GPI抗体。根据抗磷脂综合征(APS)诊断的札幌临床标准,查阅患者记录以了解既往血栓栓塞事件或产科并发症情况,并对每位患者进行体格检查。在一项多变量分析中,考虑了年龄、性别、SLE或其他自身免疫性疾病的存在以及静脉和动脉血栓栓塞的既定危险因素,结果发现LA(比值比4.4,置信区间1.5 - 13.3)和abeta2GPI抗体(比值比2.9,置信区间1.1 - 7.5)而非aCL抗体(比值比1.2,置信区间0.5 - 2.7)是血栓形成相关事件的独立危险因素。当在上述模型中分析抗磷脂抗体指标而非单个检测阳性结果时,三联阳性是一个强烈的独立危险因素(比值比33.3,置信区间7.0 - 157.6),在考虑与静脉或动脉血栓栓塞的关联时仍具有显著性。LA阴性的双阳性对于血栓形成相关事件接近显著性(比值比2.2,置信区间1.0 - 5.2,p = 0.056),对于产科并发症是高度显著的危险因素(比值比10.8,置信区间2.9 - 40.8)。其他组合未达到统计学显著性。三联阳性指标中IgG abeta2GPI抗体的平均水平在统计学上更高,这可能是LA呈阳性的原因。与单一检测相比,分析完整的抗磷脂抗体指标能更好地确定有风险的患者。

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