Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China.
Lab Med. 2022 Sep 1;53(5):495-499. doi: 10.1093/labmed/lmac028.
Antiphospholipid syndrome (APS) is an autoimmune disorder that is characterized by venous or arterial thrombosis and/or obstetric morbidity in the constant presence of persistent antiphospholipid antibodies (aPLs). In patients with APS, the relationship between production of immunoglobulin (Ig)A antiphospholipid antibodies and adverse events in pregnancy is still unclear. As a result of massive trials, the clinical efficiency of IgA-aPLs is used to evaluate pregnancy outcomes in patients with APS.
We enrolled 381 female patients with APS and 93 healthy pregnant women. Silica clotting time ratio, dilute Russell viper venom time (dRVVT) ratio, and 6 aPLs, including IgA/IgG/IgM isotypes aβ2GPI and IgA/IgG/IgM isotypes anticardiolipin (aCL), were detected using commercial kits.
We found no significant differences in laboratory parameters between patients with APS and the control group. The total prevalence of aCL IgA was 2.9%; the prevalence of aβ2GPI IgA was 3.4%. Only 1.3% of the individuals who tested aCL-positive (5/381) had isolated aCL IgA. Similarly, isolated aβ2GPI IgA was present in only 0.8% (3/381) of the aβ2GPI-positive subjects. Meanwhile, aCL IgA showed the maximum area under the curve (AUC) of 0.666 (95% CI, 0.60-0.73; P < .001), followed by dRVVT ratio (AUC = 0.649; 0.58-0.72; P < .001).
Positive aCL IgA and aβ2GPI IgA ratios were extremely low for each isolated isotype of aPLs. For patients with APS who experienced fetal loss, aCL IgA may be utilized as a risk factor for pregnancy loss among patients with APS. Establishing a standardized diagnosis of IgA aPLs is also important for these patients.
抗磷脂综合征（APS）是一种自身免疫性疾病，其特征为静脉或动脉血栓形成和/或持续存在抗磷脂抗体（aPL）时的产科并发症。在 APS 患者中，IgA 型抗磷脂抗体的产生与妊娠不良事件之间的关系仍不清楚。由于大量试验，IgA-aPLs 的临床疗效用于评估 APS 患者的妊娠结局。
我们纳入了 381 名 APS 女性患者和 93 名健康孕妇。使用商业试剂盒检测硅凝血时间比、稀释 Russell 蝰蛇毒时间（dRVVT）比和 6 种 aPL，包括 IgA/IgG/IgM 同种型 aβ2GPI 和 IgA/IgG/IgM 同种型抗心磷脂（aCL）。
我们未发现 APS 患者与对照组之间实验室参数存在显著差异。总 aCL IgA 阳性率为 2.9%；aβ2GPI IgA 阳性率为 3.4%。仅 1.3%（5/381）的 aCL 阳性个体存在孤立的 aCL IgA。同样，孤立的 aβ2GPI IgA 仅存在于 0.8%（3/381）的 aβ2GPI 阳性者中。同时，aCL IgA 的曲线下面积（AUC）最大，为 0.666（95%CI，0.60-0.73；P<.001），其次是 dRVVT 比值（AUC=0.649；0.58-0.72；P<.001）。
每种孤立的 aPL 同种型的 aCL IgA 和 aβ2GPI IgA 比值均极低。对于经历过胎儿丢失的 APS 患者，aCL IgA 可能成为 APS 患者妊娠丢失的危险因素。建立 IgA aPL 的标准化诊断对这些患者也很重要。
