Department of Medicine, Solna, Division of Rheumatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden.
J Intern Med. 2022 Mar;291(3):327-337. doi: 10.1111/joim.13409. Epub 2021 Nov 24.
Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA).
To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C-protein C inhibitor (APC-PCI) complex.
Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case-control study. Autoantibodies (IgA/G/M) targeting cardiolipin and β glycoprotein-I and specific nuclear antigens were analyzed by multiplexed bead technology. The concentration of APC-PCI was determined as a measure of hypercoagulability by an immunofluorometric sandwich assay.
Both prevalence and titers of aPL of the IgG isotype (anti-cardiolipin and/or anti-β glycoprotein-I) were higher in patients with MINOCA and MICAD than in controls. aPL IgG positivity was twice as frequent among patients with MICAD than MINOCA (11% vs. 6%, nonsignificant). We observed no group differences regarding aPL IgA/M or antibodies targeting specific nuclear antigens. Levels of APC-PCI were elevated in aPL IgG-positive compared to aPL IgG-negative MICAD patients.
aPL IgG, but not IgA/M, are enriched particularly in patients with MICAD but also in patients with MINOCA, as compared to controls. Interestingly, signs of hypercoagulability-measured by increased levels of the APC-PCI complex-were present in aPL IgG-positive MICAD patients, indicating an association with functional disturbances of the coagulation system.
最近的研究表明，在因冠状动脉疾病（MICAD）导致的心肌梗死（MI）患者中，促血栓形成的抗磷脂抗体（aPL）过度表达。然而，目前尚不清楚 aPL 是否存在于 MI 的两种亚型（MICAD 和非阻塞性冠状动脉心肌梗死（MINOCA））之间的差异。
确定 aPL 是否与 MINOCA 或 MICAD 相关，或与激活蛋白 C-蛋白 C 抑制剂（APC-PCI）复合物评估的高凝状态相关。
纳入了一项横断面病例对照研究，包括特征明确的 MINOCA 患者（n=98）、年龄和性别匹配的 MICAD 患者（n=99）和健康对照者（n=100）。通过多重微珠技术分析针对心磷脂和β糖蛋白 I 以及特定核抗原的自身抗体（IgA/G/M）。通过免疫荧光夹心测定法，以 APC-PCI 的浓度作为高凝状态的衡量指标。
MINOCA 和 MICAD 患者的 aPL IgG 同种型（抗心磷脂和/或抗β糖蛋白 I）的患病率和滴度均高于对照组。MICAD 患者的 aPL IgG 阳性率是 MINOCA 患者的两倍（11%比 6%，无显著性差异）。我们未观察到针对 IgA/M 或针对特定核抗原的 aPL 存在组间差异。与 aPL IgG 阴性的 MICAD 患者相比，aPL IgG 阳性的 MICAD 患者的 APC-PCI 水平升高。
与对照组相比，aPL IgG，但不是 IgA/M，在 MICAD 患者中更为丰富，并且在 MINOCA 患者中也更为丰富。有趣的是，通过增加 APC-PCI 复合物的水平来测量的高凝状态标志物在 aPL IgG 阳性的 MICAD 患者中存在，表明与凝血系统功能障碍有关。
