Department of Laboratory Medicine, Coagulation Laboratory, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
Curr Rheumatol Rep. 2020 Jun 19;22(8):38. doi: 10.1007/s11926-020-00916-5.
This review focuses on the laboratory tests necessary for the diagnosis of antiphospholipid syndrome (APS). For the interpretation of the results of the tests for antiphospholipid antibodies (aPL), understanding of all pitfalls and interferences is necessary.
Progress has been made on the standardization of aPL tests and current guidelines for detection of lupus anticoagulant (LAC), anticardiolipin antibodies (aCL), and antibeta2-glycoprotein I antibodies (aβ2GPI) are useful tools. LAC measurement remains a complex procedure with many pitfalls and interference by anticoagulant therapy. Solid phase assays for aCL and aβ2GPI still show inter-assay differences. Measuring LAC, aCL, and aβ2GPI allows making antibody profiles that help in identifying patients at risk. Other aPL, such as antibodies against domain I of beta2-glycoprotein I (aDI) and antiphosphatidylserine-prothrombin (aPS/PT) antibodies, may be useful in risk stratification of APS patients, but are not included in the current diagnostic criteria as no added value in the diagnosis of APS has been illustrated so far. The laboratory diagnosis of APS remains challenging. LAC, aCL, aβ2GPI IgG, and IgM should be performed to increase diagnostic efficacy, with an integrated interpretation of all results and an interpretative comment. A close interaction between clinical pathologists and clinicians is mandatory.
本篇综述重点关注抗磷脂综合征（APS）诊断所需的实验室检测。为了正确解读抗磷脂抗体（aPL）检测的结果，必须了解所有的检测陷阱和干扰因素。
在抗磷脂抗体检测的标准化方面取得了进展，目前检测狼疮抗凝物（LAC）、抗心磷脂抗体（aCL）和抗β2-糖蛋白 I 抗体（aβ2GPI）的指南是有用的工具。尽管 LAC 的测量仍然是一个复杂的过程，存在许多检测陷阱和抗凝治疗的干扰，但目前仍在使用。固相检测法用于检测 aCL 和 aβ2GPI 仍然存在检测内差异。测量 LAC、aCL 和 aβ2GPI 可以帮助确定具有风险的患者的抗体谱。其他 aPL，如针对β2-糖蛋白 I 结构域 I 的抗体（aDI）和抗磷脂酰丝氨酸-凝血酶原（aPS/PT）抗体，可能有助于 APS 患者的风险分层，但目前尚未纳入诊断标准，因为迄今为止尚未证明其在 APS 诊断中的附加价值。APS 的实验室诊断仍然具有挑战性。为了提高诊断效果，应进行 LAC、aCL、aβ2GPI IgG 和 IgM 检测，并对所有结果进行综合解读和解释性注释。临床病理学家和临床医生之间必须密切互动。
