Moore Gary W, Rangarajan Savita, Savidge Geoffrey F
Centre for Haemostasis and Thrombosis (Haemophilia Reference Centre), St Thomas' Hospital, London, England.
Clin Appl Thromb Hemost. 2008 Jul;14(3):332-7. doi: 10.1177/1076029607305099. Epub 2007 Sep 25.
Lupus anticoagulants are a heterogeneous group of autoantibodies detected by their effects on phospholipid-dependent coagulation assays. Persistent lupus anticoagulants are associated with thrombotic disease, but not all are clinically significant. Antibody heterogeneity and reagent and test variability dictate that at least 2 tests, of different types, should be used to screen lupus anticoagulants. The objective of this study was to investigate whether the activated seven lupus anticoagulant assay detects clinically significant antibodies. Eighty-two patients with antiphospholipid syndrome (APS) and 32 with systemic lupus erythematosus + positive for activated seven lupus anticoagulant and who were without thrombosis, who were positive by activated seven lupus anticoagulant assay, were investigated for lupus anticoagulants by dilute Russell's viper venom time, dilute activated partial thromboplastin time, and Taipan snake venom time, and for anticardiolipin antibodies. Fifty-seven of the APS patients were positive for lupus anticoagulants in multiple assays, 25 in activated seven lupus anticoagulant alone. Fourteen of the latter group were previously positive in other antiphospholipid antibodies assays, and 11 had only been positive for lupus anticoagulants by activated seven lupus anticoagulant. Twenty-eight had elevated anticardiolipin antibodies, 6 of whom were from the group that was positive in activated seven lupus anticoagulant only. Eight of the systemic lupus erythematosus + lupus anticoagulants (without thrombosis) patients were positive for lupus anticoagulant by activated seven lupus anticoagulant alone and had only been positive in activated seven lupus anticoagulant previously, and none had elevated anticardiolipin antibodies. The remaining 24 patients were lupus-anticoagulant positive in multiple assays, and 9 had elevated anticardiolipin antibodies. Dilute Russell's viper venom time and Dilute activated partial thromboplastin time are widely used to detect lupus anticoagulants and are considered to detect clinically significant antibodies. Activated seven lupus anticoagulant detected antibodies in APS patients who were positive by these assays and also lupus anticoagulants undetectable by the dilute Russell's viper venom time/dilute activated partial thromboplastin time reagents used, demonstrating its utility as a first-line or second-line assay.
狼疮抗凝物是一类异质性自身抗体，通过其对磷脂依赖性凝血试验的影响来检测。持续性狼疮抗凝物与血栓形成性疾病相关，但并非所有狼疮抗凝物都具有临床意义。抗体的异质性以及试剂和检测方法的变异性决定了应至少使用两种不同类型的检测来筛查狼疮抗凝物。本研究的目的是调查活化七因子狼疮抗凝物检测法能否检测出具有临床意义的抗体。对82例抗磷脂综合征（APS）患者和32例系统性红斑狼疮且活化七因子狼疮抗凝物检测呈阳性且无血栓形成的患者进行研究，通过稀释蝰蛇毒时间、稀释活化部分凝血活酶时间和太攀蛇毒时间检测狼疮抗凝物，并检测抗心磷脂抗体。57例APS患者在多种检测中狼疮抗凝物呈阳性，25例仅在活化七因子狼疮抗凝物检测中呈阳性。后一组中有14例之前在其他抗磷脂抗体检测中呈阳性，11例仅在活化七因子狼疮抗凝物检测中狼疮抗凝物呈阳性。28例抗心磷脂抗体升高，其中6例来自仅在活化七因子狼疮抗凝物检测中呈阳性的组。8例系统性红斑狼疮合并狼疮抗凝物（无血栓形成）患者仅在活化七因子狼疮抗凝物检测中狼疮抗凝物呈阳性，且之前仅在活化七因子狼疮抗凝物检测中呈阳性，无一例抗心磷脂抗体升高。其余24例患者在多种检测中狼疮抗凝物呈阳性，9例抗心磷脂抗体升高。稀释蝰蛇毒时间和稀释活化部分凝血活酶时间被广泛用于检测狼疮抗凝物，并被认为能检测出具有临床意义的抗体。活化七因子狼疮抗凝物检测法在这些检测呈阳性的APS患者中检测到了抗体，也检测到了使用稀释蝰蛇毒时间/稀释活化部分凝血活酶时间试剂无法检测到的狼疮抗凝物，证明了其作为一线或二线检测方法的实用性。
