通过评估非标准抗体改善产科抗磷脂综合征患者的诊断
Improving diagnosis in patients with obstetric antiphospholipid syndrome through the evaluation of non-criteria antibodies.
作者信息
Álvarez Daniel, Winter Hephzibah E, Velasquez Franco Carlos J, Castellanos Gutierrez Aleida Susana, Baños Núria, Markert Udo R, Cadavid Ángela P, Morales-Prieto Diana M
机构信息
Grupo Reproducción, Departamento Microbiología y Parasitología, Facultad de Medicina Universidad de Antioquia UdeA Medellín Colombia.
Placenta Lab, Department of Obstetrics Jena University Hospital Jena Germany.
出版信息
Clin Transl Immunology. 2024 Dec 13;13(12):e70021. doi: 10.1002/cti2.70021. eCollection 2024.
OBJECTIVES
Antiphospholipid syndrome (APS) is an autoimmune disease driven by antiphospholipid antibodies (aPL). Currently, APS diagnosis requires a combination of clinical manifestations (thrombosis and/or obstetric morbidity) and the persistent presence of at least one criteria aPL: anti-cardiolipin antibodies (aCL), anti-β2-glycoprotein I antibodies (aβ2GPI) or lupus anticoagulant (LA). Patients with suggestive obstetric symptoms but lacking criteria aPL face diagnostic challenges. Non-criteria aPL screening may enhance discrimination. This study proposes a classification incorporating both criteria and non-criteria antibodies to improve obstetric APS diagnosis.
METHODS
Blood samples from non-pregnant women ( = 68) with a history of vascular, obstetric, or vascular and obstetric manifestations were analysed. Among them, 30 had previous diagnosis of APS. Healthy women with proven gestational success were included as controls ( = 16). Criteria and non-criteria (anti-phosphatidylglycerol, anti-phosphatidylethanolamine, anti-phosphatidylinositol, anti-phosphatidylserine and anti-phosphatidic acid) IgG aPL were evaluated by ELISA and coagulation tests. Based on the resulting aPL profile, patients were reclassified. Responsiveness to treatment was obtained from medical records.
RESULTS
Criteria aPL levels marginally differentiated women previously managed as obstetric APS from unexplained/other causes of obstetric morbidity. Including non-criteria aPL improved separation. The proposed classification identified an obstetric APS group that exhibits non-criteria aPL and aβ2GPI titres below the cut-off but higher than healthy women (7.88 vs. 2.47 SGU, = 0.006). Compared to cases of other causes of obstetric morbidity, these patients retrospectively responded better to aspirin and/or heparin treatment (71.43% vs. 11.11%, = 0.035).
CONCLUSIONS
Assessing non-criteria antibodies may identify isolated obstetric APS cases benefiting from established therapies.
目的
抗磷脂综合征（APS）是一种由抗磷脂抗体（aPL）驱动的自身免疫性疾病。目前，APS的诊断需要结合临床表现（血栓形成和/或产科并发症）以及至少一种标准aPL的持续存在：抗心磷脂抗体（aCL）、抗β2糖蛋白I抗体（aβ2GPI）或狼疮抗凝物（LA）。有提示性产科症状但缺乏标准aPL的患者面临诊断挑战。非标准aPL筛查可能会提高鉴别能力。本研究提出一种纳入标准和非标准抗体的分类方法，以改善产科APS的诊断。
方法
分析了有血管、产科或血管和产科表现病史的非妊娠女性（n = 68）的血样。其中，30例先前被诊断为APS。纳入有成功妊娠记录的健康女性作为对照（n = 16）。通过酶联免疫吸附测定（ELISA）和凝血试验评估标准和非标准（抗磷脂酰甘油、抗磷脂酰乙醇胺、抗磷脂酰肌醇、抗磷脂酰丝氨酸和抗磷脂酸）IgG aPL。根据所得的aPL谱对患者进行重新分类。从医疗记录中获取对治疗的反应情况。
结果
标准aPL水平仅略微区分了先前被诊断为产科APS的女性与不明原因/其他产科并发症原因的女性。纳入非标准aPL可改善区分效果。所提出的分类方法确定了一个产科APS组，该组表现出非标准aPL和aβ2GPI滴度低于临界值但高于健康女性（7.88对2.47 SGU，P = 0.006）。与其他产科并发症原因的病例相比，可以回顾性地发现这些患者对阿司匹林和/或肝素治疗的反应更好（71.43%对11.11%，P = 0.035）。
结论
评估非标准抗体可能会识别出受益于既定疗法的孤立性产科APS病例。
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