Department of Medicine, Jagiellonian University Medical College, Krakow, Poland.
J Thromb Haemost. 2011 Sep;9(9):1776-83. doi: 10.1111/j.1538-7836.2011.04420.x.
Lupus anticoagulant (LA) is clinically the most relevant among all antiphospholipid antibody tests. Recently, new guidelines for LA detection were published. The objective of this retrospective cohort study was to compare tests recommended under these guidelines with other methods used for LA detection.
The study group consisted of 336 subjects suffering from various autoimmune diseases. We used activated partial thromboplastin time (aPTT), diluted Russell viper venom time (dRVVT) and diluted prothrombin time (dPT) tests for LA detection together with a ratio between sensitive and insensitive aPTT reagent. We also tested if LA was dependent on β(2) glycoprotein I (β(2) GPI) using one of the recently described methods.
All LA tests performed were associated with a history of thrombosis. The highest odds ratio (OR) for thrombosis was found for β(2) GPI-dependent LA but sensitivity was low (OR = 8.4; specificity/sensitivity = 98%/15%). All LA tests showed a much stronger association with thrombosis than with pregnancy failure.
LA tested by aPTT and/or dRVVT (at least one out of two tests positive), as recommended by the guidelines, was associated less strongly with a history of thrombosis (OR = 4.1) than either of these tests separately (OR = 5.0 and 4.3, respectively). With both tests positive ('double LA positivity') the association with thrombosis was stronger (OR = 6.5) compared with only one positive test. In fact, 'double LA positivity', detected by combinations of any of the tests studied, was markedly associated with a history of thrombosis.
狼疮抗凝物（LA）是所有抗磷脂抗体检测中临床最相关的。最近，新的 LA 检测指南已经发布。本回顾性队列研究的目的是比较这些指南推荐的检测方法与用于 LA 检测的其他方法。
研究组由 336 例患有各种自身免疫性疾病的患者组成。我们使用活化部分凝血活酶时间（aPTT）、稀释蝰蛇毒时间（dRVVT）和稀释凝血酶原时间（dPT）检测 LA，并使用敏感和不敏感 aPTT 试剂的比值进行检测。我们还使用最近描述的一种方法来检测 LA 是否依赖β(2)糖蛋白 I（β(2) GPI）。
所有进行的 LA 检测均与血栓形成史相关。与血栓形成最相关的是β(2) GPI 依赖性 LA，但敏感性较低（OR=8.4；特异性/敏感性=98%/15%）。所有 LA 检测均与血栓形成的相关性强于与妊娠失败的相关性。
指南推荐的 aPTT 和/或 dRVVT（至少有一项阳性）检测的 LA 与血栓形成史的相关性较弱（OR=4.1），与单独使用这两种方法相比（OR=5.0 和 4.3）。两项检测均为阳性（“双重 LA 阳性”）与血栓形成的相关性更强（OR=6.5），与仅有一项阳性检测相比。实际上，任何研究检测方法的组合检测到的“双重 LA 阳性”与血栓形成史明显相关。
