Fleck R A, Rapaport S I, Rao L V
Department of Pathology, University of California School of Medicine, San Diego.
Blood. 1988 Aug;72(2):512-9.
The investigators have evaluated the frequency and manifestations of anti-prothrombin antibodies in patients with the lupus anticoagulant. Thirty-one of 42 patients with lupus anticoagulants associated with a variety of underlying conditions (74%) had evidence on crossed immunoelectrophoresis of anti-prothrombin antibodies. Twenty-four of 25 patients with an activated partial thromboplastin time exceeding 50 seconds and 14 of 15 patients with a prothrombin time exceeding control by more than two seconds had demonstrable anti-prothrombin antibodies. Three of the 31 patients with anti-prothrombin antibodies had essentially no measurable plasma prothrombin, a presumed result of accelerated clearance of prothrombin/prothrombin antibody complexes. Each of these patients had bled abnormally. The remaining patients with anti-prothrombin antibodies had neither substantial hypoprothrombinemia nor hemorrhagic manifestations, which confirms the non-neutralizing property of anti-prothrombin antibodies associated with the lupus anticoagulant. Since lupus anticoagulant immunoglobulins are known to react with phospholipids, the high prevalence of antibodies binding prothrombin led us to test the hypothesis of antibody polyreactivity. Adsorption of three lupus anticoagulant plasmas with insolubilized prothrombin markedly diminished evidence of both prothrombin/prothrombin antibody complexes and anticoagulant activity. Eluates of the insolubilized prothrombin contained IgG that not only bound prothrombin but possessed lupus anticoagulant activity.
研究人员评估了狼疮抗凝物患者中抗凝血酶原抗体的频率和表现。42例患有狼疮抗凝物且伴有多种潜在疾病的患者中，有31例（74%）在交叉免疫电泳中显示有抗凝血酶原抗体的证据。活化部分凝血活酶时间超过50秒的25例患者中有24例，凝血酶原时间超过对照2秒以上的15例患者中有14例，检测到了抗凝血酶原抗体。31例有抗凝血酶原抗体的患者中，有3例血浆中几乎测不到凝血酶原，推测这是凝血酶原/凝血酶原抗体复合物加速清除的结果。这些患者均有异常出血表现。其余有抗凝血酶原抗体的患者既没有明显的低凝血酶原血症，也没有出血表现，这证实了与狼疮抗凝物相关的抗凝血酶原抗体的非中和特性。由于已知狼疮抗凝物免疫球蛋白可与磷脂发生反应，结合凝血酶原的抗体的高患病率促使我们检验抗体多反应性的假说。用不溶性凝血酶原吸附三种狼疮抗凝物血浆，可明显减少凝血酶原/凝血酶原抗体复合物和抗凝活性的证据。不溶性凝血酶原的洗脱液中含有IgG，它不仅能结合凝血酶原，还具有狼疮抗凝活性。
