McNeil H P, Chesterman C N, Krilis S A
University of New South Wales, School of Medicine, St. George Hospital, Sydney, Australia.
Thromb Res. 1988 Dec 15;52(6):609-19. doi: 10.1016/0049-3848(88)90133-8.
Antiphospholipid antibodies have been found to be strongly associated with syndromes characterised by spontaneous arterial and venous thromboses, recurrent miscarriage, immune thrombocytopenia, and occasionally neurological manifestations. These antibodies can be detected using solid phase immunoassays, and by their effect on prolonging phospholipid dependent clotting tests. This latter phenomenon is termed the lupus anticoagulant (LA). The relationship between anticardiolipin antibodies (ACA) and the LA activity of plasma was investigated in 14 patients. Plasma of these patients exhibited both LA activity and high levels of ACA. The patients included 7 with systemic lupus erythematosus, 6 without and 1 chlorpromazine induced lupus anticoagulant. 7 patients had a history of thrombosis and 7 did not, despite high antibody levels. Plasma was incubated in a serial fashion with solid phase cardiolipin and the residual ACA level and LA activity were monitored using a solid phase enzyme linked immunoassay, and the kaolin clotting time (KCT) and activated partial thromboplastin time (APTT) respectively. There was no correlation between baseline ACA levels and parameters of LA activity (dKCT or dAPTT) in contrast to previous reports. However, there was a concurrent reduction in both LA and ACA levels over 24 hours during incubation with cardiolipin in all patients. The rate of reduction of both parameters was highly correlated (r = 0.99. p less than 0.001). The relative reduction of LA activity versus ACA level varied between patients, and may represent different affinities for phospholipid in thromboplastin versus phospholipid in solid phase. Thus, despite the lack of concordance between LA and ACA in many patients, the two activities can be removed concurrently in vitro, suggesting similar binding specificities of the antibodies. The incomplete concordance could be explained by varying affinities for different structural presentations of the lipid antigen.
抗磷脂抗体已被发现与以自发性动静脉血栓形成、复发性流产、免疫性血小板减少症以及偶尔出现的神经学表现为特征的综合征密切相关。这些抗体可通过固相免疫测定法检测，也可通过其延长磷脂依赖性凝血试验的作用来检测。后一种现象被称为狼疮抗凝物（LA）。对14例患者的抗心磷脂抗体（ACA）与血浆LA活性之间的关系进行了研究。这些患者的血浆同时表现出LA活性和高水平的ACA。患者包括7例系统性红斑狼疮患者、6例非系统性红斑狼疮患者和1例氯丙嗪诱导的狼疮抗凝物患者。7例患者有血栓形成史，7例没有，尽管抗体水平很高。将血浆与固相心磷脂进行系列孵育，分别使用固相酶联免疫测定法监测残余ACA水平，使用高岭土凝血时间（KCT）和活化部分凝血活酶时间（APTT）监测LA活性。与先前的报告相反，基线ACA水平与LA活性参数（dKCT或dAPTT）之间没有相关性。然而，在所有患者中，与心磷脂孵育24小时期间，LA和ACA水平同时降低。两个参数的降低速率高度相关（r = 0.99，p小于0.001）。LA活性相对于ACA水平的相对降低在患者之间有所不同，可能代表组织凝血活酶中的磷脂与固相中磷脂的不同亲和力。因此，尽管许多患者的LA和ACA不一致，但这两种活性在体外可同时去除，表明抗体具有相似的结合特异性。不完全一致可以用对脂质抗原不同结构形式的不同亲和力来解释。
