Devreese Katrien M J
Department of Diagnostic Sciences, Coagulation Laboratory, Ghent University Hospital, Ghent University, Ghent, Belgium.
Semin Thromb Hemost. 2024 Oct 7. doi: 10.1055/s-0044-1791699.
Antiphospholipid syndrome (APS) diagnosis hinges on identifying antiphospholipid antibodies (aPL). Currently, laboratory testing encompasses lupus anticoagulant (LA), anticardiolipin (aCL), and anti-β2-glycoprotein I antibodies (aβ2GPI) IgG or IgM, which are included in the APS classification criteria. All the assays needed to detect aPL antibodies have methodological concerns. LA testing remains challenging due to its complexity and susceptibility to interference from anticoagulant therapy. Solid phase assays for aCL and aβ2GPI exhibit discrepancies between different assays. Antibody profiles aid in identifying the patients at risk for thrombosis through integrated interpretation of all positive aPL tests. Antibodies targeting domain I of β2-glycoprotein and antiphosphatidylserine-prothrombin antibodies have been evaluated for their role in thrombotic APS but are not yet included in the APS criteria. Detecting these antibodies may help patients with incomplete antibody profiles and stratify the risk of APS patients. The added diagnostic value of other methodologies and measurements of other APS-associated antibodies are inconsistent. This manuscript describes laboratory parameters useful in the diagnosis of thrombotic APS and will concentrate on the laboratory aspects, clinical significance of assays, and interpretation of aPL results in the diagnosis of thrombotic APS.
抗磷脂综合征（APS）的诊断取决于抗磷脂抗体（aPL）的识别。目前，实验室检测包括狼疮抗凝物（LA）、抗心磷脂（aCL）以及抗β2糖蛋白I抗体（aβ2GPI）的IgG或IgM，这些都包含在APS分类标准中。检测aPL抗体所需的所有检测方法都存在方法学问题。由于LA检测复杂且易受抗凝治疗干扰，其检测仍具有挑战性。aCL和aβ2GPI的固相检测在不同检测方法之间存在差异。抗体谱通过对所有阳性aPL检测结果的综合解读，有助于识别有血栓形成风险的患者。针对β2糖蛋白结构域I的抗体和抗磷脂酰丝氨酸 - 凝血酶原抗体在血栓性APS中的作用已得到评估，但尚未纳入APS标准。检测这些抗体可能有助于抗体谱不完整的患者，并对APS患者的风险进行分层。其他方法和其他APS相关抗体检测的附加诊断价值并不一致。本文描述了对血栓性APS诊断有用的实验室参数，并将重点关注实验室方面、检测的临床意义以及aPL检测结果在血栓性APS诊断中的解读。
