Matsuura Y, Nawata Y, Miike S, Hiraguri M, Kita Y, Kurasawa K, Takabayashi K, Oh H, Iwamoto I, Saito Y
Second Department of Internal Medicine, School of Medicine, Chiba University, Japan.
Ryumachi. 1996 Feb;36(1):16-24.
Lupus anticoagulants (LA) and anticardiolipin antibodies (aCL) are known as thrombosis-related antiphospholipid antibodies. LA is not as well characterized as aCL, and the relation between LA and aCL is not clarified. Since standardized method for the detection of LA has not been established, we measured LA activities in outpatients with SLE by using two different methods (KCT and dRVVT), and analyzed the characteristics of LA in SLE. LA was detected in 29.8% of all samples (14.3% in both methods, 15.5% in one method). IgG-aCL and IgM-aCL was detected in 38% and 20%, respectively, of all LA positive samples. Though a good correlation was observed between LA activities and IgG-aCL levels, a considerable number of LA positive samples were negative for aCL. This indicated the presence of factors with LA activity other than aCL. On the contrary there was also a high percentage of LA negative samples with positive aCL (42.4% in IgG-aCL, 47.4% in IgM-aCL), suggesting the presence of aCL with poor or low LA activity. These findings showed the heterogeneity of antiphospholipid antibodies both in LA and in aCL. The platelet function tests showed increased platelet adhesiveness and normal platelet aggregation in LA positive patients with SLE even in the inactive phase. The serum levels of factors such as protein C, protein S, antithrombin III and thrombomodulin were within normal range. Clinical features such as hemolytic anemia, thrombosis and abortion were more frequently observed in LA positive population than in LA negative population. The clinical features tend to be different between patients with dRVVT-LA and those with KCT-LA, though not significant. Because of the heterogeneity in LA, a combination of more than two different methods including dRVVT was recommended for the detection and the evaluation of LA.
狼疮抗凝物（LA）和抗心磷脂抗体（aCL）是已知的与血栓形成相关的抗磷脂抗体。LA的特征不如aCL明确，且LA与aCL之间的关系尚未阐明。由于尚未建立检测LA的标准化方法，我们采用两种不同方法（KCT和dRVVT）测定了系统性红斑狼疮（SLE）门诊患者的LA活性，并分析了SLE中LA的特征。在所有样本中，29.8%检测到LA（两种方法均检测到的占14.3%，仅一种方法检测到的占15.5%）。在所有LA阳性样本中，IgG-aCL和IgM-aCL的检测率分别为38%和20%。虽然观察到LA活性与IgG-aCL水平之间存在良好相关性，但相当数量的LA阳性样本aCL呈阴性。这表明存在除aCL之外具有LA活性的因素。相反，也有相当比例的LA阴性样本aCL呈阳性（IgG-aCL为42.4%，IgM-aCL为47.4%），提示存在LA活性较差或较低的aCL。这些发现表明抗磷脂抗体在LA和aCL方面均具有异质性。血小板功能测试显示，即使在非活动期，SLE的LA阳性患者血小板黏附性增加而血小板聚集正常。蛋白C、蛋白S、抗凝血酶III和血栓调节蛋白等因子的血清水平在正常范围内。与LA阴性人群相比，LA阳性人群中溶血性贫血、血栓形成和流产等临床特征更为常见。dRVVT-LA患者和KCT-LA患者的临床特征虽无显著差异，但倾向于有所不同。由于LA存在异质性，建议采用包括dRVVT在内的两种以上不同方法联合检测和评估LA。
