Miesbach Wolfgang, Matthias Torsten, Scharrer Inge
Johann Wolfgang Goethe University, Frankfurt/Main Medical Clinic III, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
Ann N Y Acad Sci. 2005 Jun;1050:250-6. doi: 10.1196/annals.1313.026.
Venous or arterial thrombosis, abortion, and the presence of antiphospholipid antibodies (aPL) define the criteria for the antiphospholipid syndrome (APS). A heterogeneous group of antibodies against phospholipids and plasma proteins may influence several coagulation pathways and lead to thrombophilia. We investigated the presence of antibodies to thrombin (Thr) in patients with aPL and reviewed their clinical manifestations. IgG and IgM titers of aPL were measured by ELISA (Aesku.Diagnostics, Wendelsheim, Germany). Lupus anticoagulants (LA) were measured according to the criteria of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. One hundred twenty patients were identified with LA or anticardiolipin (aCL). Of the 120 patients, 98 (82%) had primary APS and 22 (18%) had secondary APS. Further, 76/120 (63%) were suffering from thromboembolic manifestations, mostly venous thrombosis. Anti-thrombin-IgG was detected in 20%, and anti-thrombin-IgM was detected in 23% of the patients. The presence of anti-thrombin antibodies was closely related to the presence of anti-beta(2)-glycoprotein-I (beta(2)-GP-I) (96%), aCL (97%), and LA (87%), and less well to the presence of anti-phosphatidylserine/prothrombin (Ser/Pro) antibodies (71%) or anti-prothrombin antibodies (Pro) (50%). Sixty-seven percent of the patients with anti-Thr-IgG suffered from thromboembolic complications, mostly arterial thrombosis. The rate of thrombosis was higher for these patients than for patients with anti-beta(2)-GP-I antibodies (37/60, 62%), LA (50/79, 63%), or anti-Ser/Pro antibodies (18/28, 64%). Anti-thrombin antibodies were found in 20% of patients with aPL; 67% of these patients were admitted with thrombotic manifestations of APS. The presence of anti-thrombin antibodies was closely associated with the presence of aCL and anti-beta(2)-GP-I antibodies. The sensitivity of the test for anti-thrombin antibodies for the diagnosis of APS was higher than the sensitivity of the anti-prothrombin assay and similar to the sensitivity of the anti-Ser/Pro assay.
静脉或动脉血栓形成、流产以及抗磷脂抗体（aPL）的存在定义了抗磷脂综合征（APS）的标准。一组针对磷脂和血浆蛋白的异质性抗体可能影响多种凝血途径并导致血栓形成倾向。我们调查了aPL患者中抗凝血酶（Thr）抗体的存在情况，并回顾了他们的临床表现。通过酶联免疫吸附测定法（ELISA，德国温德尔斯海姆的艾斯库诊断公司）检测aPL的IgG和IgM滴度。根据国际血栓与止血学会科学和标准化委员会的标准检测狼疮抗凝物（LA）。确定120例患者存在LA或抗心磷脂（aCL）。在这120例患者中，98例（82%）患有原发性APS，22例（18%）患有继发性APS。此外，120例中有76例（63%）有血栓栓塞表现，主要是静脉血栓形成。20%的患者检测到抗凝血酶-IgG，23%的患者检测到抗凝血酶-IgM。抗凝血酶抗体的存在与抗β2糖蛋白-I（β2-GP-I）（96%）、aCL（97%）和LA（87%）的存在密切相关，与抗磷脂酰丝氨酸/凝血酶原（Ser/Pro）抗体（71%）或抗凝血酶原抗体（Pro）（50%）的存在相关性较差。抗Thr-IgG患者中有67%患有血栓栓塞并发症，主要是动脉血栓形成。这些患者的血栓形成发生率高于抗β2-GP-I抗体患者（37/60，62%）、LA患者（50/79，63%）或抗Ser/Pro抗体患者（18/28，64%）。aPL患者中有20%发现抗凝血酶抗体；这些患者中有67%因APS的血栓形成表现入院。抗凝血酶抗体的存在与aCL和抗β2-GP-I抗体的存在密切相关。抗凝血酶抗体检测对APS诊断的敏感性高于抗凝血酶原检测，与抗Ser/Pro检测的敏感性相似。
