Division of Hematology, Duke University Medical Center, Durham, North Carolina, USA.
Am J Hematol. 2012 May;87 Suppl 1(Suppl 1):S75-81. doi: 10.1002/ajh.23196. Epub 2012 Mar 31.
The antiphospholipid syndrome (APS) is diagnosed in patients with recurrent thromboembolic events and/or pregnancy loss in the presence of persistent laboratory evidence for antiphospholipid antibodies. Diagnostic tests for the detection of antiphospholipid antibodies include laboratory assays that detect anticardiolipin antibodies, lupus anticoagulants, and anti-β(2)-glycoprotein I antibodies. These assays have their origins beginning >60 years ago, with the identification of the biologic false positive test for syphilis, the observation of "circulating anticoagulants" in certain patients with systemic lupus erythematosus, the identification of cardiolipin as a key component in the serologic test for syphilis, and the recognition and characterization of a "cofactor" for antibody binding to phospholipids. Although these assays have been used clinically for many years, there are still problems with the accurate diagnosis of patients with this syndrome. For example, lupus anticoagulant testing can be difficult to interpret in patients receiving anticoagulant therapy, but most patients with a thromboembolic event will already be anticoagulated before the decision to perform the tests has been made. In addition to understanding limitations of the assays, clinicians also need to be aware of which patients should be tested and not obtain testing on patients unlikely to have APS. New tests and diagnostic strategies are in various stages of development and should help improve our ability to accurately diagnose this important clinical disorder.
抗磷脂综合征（APS）是在存在持续的抗磷脂抗体实验室证据的情况下，诊断为复发性血栓栓塞事件和/或妊娠丢失的患者。用于检测抗磷脂抗体的诊断测试包括检测抗心磷脂抗体、狼疮抗凝物和抗β(2)-糖蛋白 I 抗体的实验室检测。这些检测方法起源于 60 多年前，当时发现了梅毒的生物学假阳性检测，观察到系统性红斑狼疮患者存在“循环抗凝剂”，鉴定出心磷脂是梅毒血清学检测的关键成分，并认识和描述了与抗体结合的“辅助因子”。尽管这些检测方法已在临床上使用多年，但在准确诊断该综合征患者方面仍存在问题。例如，在接受抗凝治疗的患者中，狼疮抗凝物检测可能难以解释，但大多数发生血栓栓塞事件的患者在决定进行检测之前已经接受了抗凝治疗。除了了解检测方法的局限性外，临床医生还需要了解哪些患者应该进行检测，以及哪些不太可能患有 APS 的患者不应进行检测。新的检测和诊断策略处于不同的发展阶段，应该有助于提高我们准确诊断这一重要临床疾病的能力。
