抗磷脂抗体综合征与系统性红斑狼疮患者中抗 I 型 β 糖蛋白 1 抗体。

Antibodies to Domain I β-Glycoprotein 1 in Patients with Antiphospholipid Syndrome and Systemic Lupus Erythematosus.

机构信息

Nasonova Research Institute of Rheumatology, Moscow, Russia.

Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.

出版信息

Dokl Biochem Biophys. 2023 Aug;511(1):219-226. doi: 10.1134/S1607672923700278. Epub 2023 Oct 13.

DOI:10.1134/S1607672923700278

PMID:37833609

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10739196/

Abstract

The role of antiphospholipid antibodies (aPL), which are not included in the Sydney diagnostic criteria, in antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) is poorly understood. The aim of this study was to determine the clinical significance of IgG antibodies for domain 1 of β-glycoprotein 1 (β-GP1), IgG anti-β-GP1DI, in patients with APS with and without SLE. The study included 187 patients with APS with or without SLE, 49 patients formed the comparison group, and 100 apparently healthy individuals formed the control group. IgG/IgM antibodies to cardiolipin (aCL) and IgG/IgM anti-β-GP1 were determined by enzyme immunoassay (ELISA) in patients with or without APS, and IgG anti-β-GP1DI was determined by chemiluminescence assay (CLA) in all patients and controls. IgG anti-β-GP1DI was detected in 37 (71%) of 52 patients with primary APS (PAPS), in 6 (50%) of 12 patients with probable APS, in 42 (71%) of 59 patients with SLE + APS, in 17 (26%) of 64 patients with SLE, in 1 (2%) of the comparison group, and in none of the control group. IgG anti-β-GP1DI was significantly associated with PAPS and SLE + APS compared with the patients with SLE (p = 0.0002 and 0.0001, respectively). The association of IgG anti-β-GP1DI with clinical manifestations of APS (thrombosis (p = 0.001) and obstetric pathology (p = 0.04)) was detected. There was a significant association of IgG anti-β-GP1DI with arterial thrombosis (p = 0.002) and with late gestational obstetric pathology (p = 0.01). High specificity of IgG anti-β-GP1DI depending on the diagnosis and clinical manifestations of APS despite low sensitivity was noted: specificity was 84% for thrombosis, 94% for obstetric pathology, and 89% for APS. Isolated IgG anti-β-GP1DI positivity was reported in 2% of 50 aPL-negative patients and was not associated with APS manifestations. The frequency of IgG anti-β-GP1DI detection was higher in the patients with APS compared to the patients with SLE, comparison group, and control (p < 0.05). Positive IgG anti-β-GP1DI values were significantly associated with thrombotic complications and with obstetric pathology (p = 0.002 and p = 0.01, respectively). Specificity of IgG anti-β-GP1DI for APS and its clinical manifestations (thrombosis and obstetric pathology) was higher than sensitivity (89, 94, and 84%, respectively).

摘要

抗磷脂抗体（aPL）在抗磷脂综合征（APS）和系统性红斑狼疮（SLE）中的作用尚未完全阐明，且不在悉尼诊断标准中。本研究旨在确定 IgG 型 β2-糖蛋白 1 抗体（β-GP1）、IgG 抗-β-GP1DI 在伴有和不伴有 SLE 的 APS 患者中的临床意义。该研究纳入了 187 例 APS 患者（伴或不伴 SLE）、49 例为对照组、100 例健康人为对照组。采用酶联免疫吸附试验（ELISA）检测 APS 患者的 IgG/IgM 型抗心磷脂抗体（aCL）和 IgG/IgM 抗-β-GP1，采用化学发光法（CLA）检测所有患者和对照组的 IgG 抗-β-GP1DI。结果显示，52 例原发性 APS（PAPS）患者中有 37 例（71%）、12 例疑似 APS 患者中有 6 例（50%）、59 例 SLE+APS 患者中有 42 例（71%）、64 例 SLE 患者中有 17 例（26%）、对照组中有 1 例（2%）、对照组中均未检测到 IgG 抗-β-GP1DI。与 SLE 患者相比，PAPS 和 SLE+APS 患者的 IgG 抗-β-GP1DI 明显更高（p=0.0002 和 0.0001）。还发现 IgG 抗-β-GP1DI 与 APS 的临床表现（血栓形成（p=0.001）和产科病理（p=0.04））有关。IgG 抗-β-GP1DI 与动脉血栓形成（p=0.002）和晚期妊娠产科病理（p=0.01）显著相关。尽管敏感性较低，但 IgG 抗-β-GP1DI 对 APS 的诊断和临床表现具有较高的特异性：其对血栓形成的特异性为 84%，对产科病理的特异性为 94%，对 APS 的特异性为 89%。在 50 例 aPL 阴性患者中，有 2%的患者单独出现 IgG 抗-β-GP1DI 阳性，且与 APS 表现无关。与 SLE 患者、对照组和健康对照组相比，APS 患者的 IgG 抗-β-GP1DI 检出率更高（p<0.05）。阳性 IgG 抗-β-GP1DI 值与血栓形成并发症和产科病理显著相关（p=0.002 和 p=0.01）。IgG 抗-β-GP1DI 对 APS 及其临床表现（血栓形成和产科病理）的特异性高于敏感性（分别为 89%、94%和 84%）。