Violi F, Ferro D, Valesini G, Quintarelli C, Saliola M, Grandilli M A, Balsano F
Institute of Clinical Medicine I, University of Rome La Sapienza, Italy.
BMJ. 1990 Apr 28;300(6732):1099-102. doi: 10.1136/bmj.300.6732.1099.
To examine the relations among tissue plasminogen activator antigen, plasminogen activator inhibitor, the lupus anticoagulant, and anticardiolipin antibodies in patients with systemic lupus erythematosus.
Prospective study of blood samples (a) from selected patients with systemic lupus erythematosus whose disease was and was not complicated by a history of thrombosis or recurrent abortions, or both, and (b) from a series of healthy controls with a similar age and sex distribution.
University based medical clinic.
23 Patients with definite systemic lupus erythematosus (American Rheumatism Association criteria), of whom 11 (eight women) aged 26-51 had a history of thrombosis or recurrent abortions, or both, and 12 (10 women) aged 23-53 had no such history. 15 Healthy subjects (10 women) aged 25-58 served as controls.
Tissue plasminogen activator concentrations, plasminogen activator inhibitor activities, detection of the lupus anticoagulant, and values of anticardiolipin antibodies in the two groups of patients and in the patients with a history of thrombosis or abortions compared with controls. Other measurements included concentrations of proteins that are known to change during the acute phase of systemic lupus erythematosus--namely, fibrinogen, C3 and C4, and C reactive protein.
Patients with a history of thrombosis or abortions, or both, had significantly higher values of tissue plasminogen activator and plasminogen activator inhibitor than patients with no such history. A significant correlation between tissue plasminogen activator and plasminogen activator inhibitor (r = 0.80) was found only in the patients with a history of complications of their disease. The lupus anticoagulant was detected in six of the 11 patients with a history of thrombosis or abortions when tested by measuring the activated partial thromboplastin time but was found in all 11 patients when tested by measuring the diluted activated partial thromboplastin time. Nine of these 11 patients had raised values of anticardiolipin antibodies. The findings showed no relation to the activity of the disease.
A significant correlation between tissue plasminogen activator concentrations and plasminogen activator inhibitor activities was found only in patients whose systemic lupus erythematosus was complicated by a history of thrombosis or recurrent abortions. The findings show that these patients have raised plasminogen activator inhibitor activities, and the frequent association between these raised activities and the presence of the lupus anticoagulant suggests that the two may be linked.
研究系统性红斑狼疮患者组织型纤溶酶原激活物抗原、纤溶酶原激活物抑制剂、狼疮抗凝物及抗心磷脂抗体之间的关系。
对血液样本进行前瞻性研究，样本来源为：（a）部分系统性红斑狼疮患者，其疾病有或无血栓形成史或反复流产史，或两者兼具；（b）一系列年龄和性别分布相似的健康对照者。
大学附属医院诊所。
23例确诊为系统性红斑狼疮的患者（符合美国风湿病协会标准），其中11例（8名女性）年龄在26 - 51岁，有血栓形成史或反复流产史，或两者兼具；12例（10名女性）年龄在23 - 53岁，无上述病史。15名健康受试者（10名女性）年龄在25 - 58岁作为对照。
两组患者以及有血栓形成史或流产史的患者与对照组相比，组织型纤溶酶原激活物浓度、纤溶酶原激活物抑制剂活性、狼疮抗凝物检测结果及抗心磷脂抗体值。其他测量指标包括已知在系统性红斑狼疮急性期会发生变化的蛋白质浓度，即纤维蛋白原、C3和C4以及C反应蛋白。
有血栓形成史或流产史，或两者兼具的患者，其组织型纤溶酶原激活物和纤溶酶原激活物抑制剂的值显著高于无上述病史的患者。仅在有疾病并发症史的患者中发现组织型纤溶酶原激活物与纤溶酶原激活物抑制剂之间存在显著相关性（r = 0.80）。通过测量活化部分凝血活酶时间检测时，11例有血栓形成史或流产史的患者中有6例检测到狼疮抗凝物，而通过测量稀释活化部分凝血活酶时间检测时，11例患者均检测到狼疮抗凝物。这11例患者中有9例抗心磷脂抗体值升高。这些结果与疾病活动度无关。
仅在系统性红斑狼疮合并血栓形成史或反复流产史的患者中发现组织型纤溶酶原激活物浓度与纤溶酶原激活物抑制剂活性之间存在显著相关性。研究结果表明，这些患者的纤溶酶原激活物抑制剂活性升高，且这些升高的活性与狼疮抗凝物的存在频繁相关，提示两者可能存在关联。
