Silver R M, Pierangeli S S, Edwin S S, Umar F, Harris E N, Scott J R, Branch D W
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City 84132, USA.
Am J Obstet Gynecol. 1997 Mar;176(3):628-33. doi: 10.1016/s0002-9378(97)70559-3.
Our goal was to determine whether women with clinical features of antiphospholipid syndrome but negative test results for lupus anticoagulant and anticardiolipin antibodies have pathogenic antibodies not identified by currently used methods.
Sera were obtained from women with clinical features associated with antiphospholipid antibodies who had negative test results for lupus anticoagulant and anticardiolipin antibodies (antiphospholipid syndrome-like). We studied (1) the effect of passive immunization with their purified immunoglobulin G fraction on murine pregnancy (n = 35) and (2) the presence of antiphospholipid antibodies other than lupus anticoagulant or anticardiolipin antibodies (n = 39). Sera were also retested for anticardiolipin antibodies and lupus anticoagulant.
Fetal loss occurred in 235 of 1088 (22%) pups in 137 mice immunized with immunoglobulin G fraction from antiphospholipid syndrome-like women compared with 23 of 402 (6%) pups in 53 control mice. Immunoglobulin G from 11 study patients resulted in the loss of at least one third of the exposed pups. Five women had positive levels of antiphosphatidylserine antibodies (>99th percentile). All levels were low positive, and three women also had low-positive levels of anticardiolipin antibodies on repeat testing. Five of the 11 (45%) women whose immunoglobulin G fractions caused at least 33% fetal loss also had positive test results for antiphospholipid antibodies.
A subset of women with clinical disorders suspicious for antiphospholipid syndrome but who had negative test results for lupus anticoagulant and anticardiolipin antibodies by current methods have serum immunoglobulin G that is pathogenic to murine pregnancy. Testing for pathogenic immunoglobulin G may provide additional means to identify women with an as yet uncharacterized immune condition. The clinical relevance of low levels of antiphospholipid antibodies in these women remains unproved.
我们的目标是确定具有抗磷脂综合征临床特征但狼疮抗凝物和抗心磷脂抗体检测结果为阴性的女性是否存在目前所用方法未识别出的致病性抗体。
从具有抗磷脂抗体相关临床特征且狼疮抗凝物和抗心磷脂抗体检测结果为阴性（类抗磷脂综合征）的女性中获取血清。我们研究了：（1）用其纯化的免疫球蛋白G组分进行被动免疫对小鼠妊娠的影响（n = 35）；（2）除狼疮抗凝物或抗心磷脂抗体之外的抗磷脂抗体的存在情况（n = 39）。血清还重新检测了抗心磷脂抗体和狼疮抗凝物。
用类抗磷脂综合征女性的免疫球蛋白G组分免疫的137只小鼠中，1088只幼崽中有235只（22%）发生胎儿丢失，而53只对照小鼠中402只幼崽中有23只（6%）发生胎儿丢失。11名研究患者的免疫球蛋白G导致至少三分之一的暴露幼崽丢失。5名女性抗磷脂酰丝氨酸抗体水平呈阳性（>第99百分位数）。所有水平均为低阳性，3名女性在重复检测时抗心磷脂抗体水平也为低阳性。其免疫球蛋白G组分导致至少33%胎儿丢失的11名女性中有5名（45%）抗磷脂抗体检测结果也呈阳性。
一部分具有疑似抗磷脂综合征临床病症但目前方法检测狼疮抗凝物和抗心磷脂抗体结果为阴性的女性，其血清免疫球蛋白G对小鼠妊娠具有致病性。检测致病性免疫球蛋白G可能为识别患有尚未明确的免疫病症的女性提供额外方法。这些女性中低水平抗磷脂抗体的临床相关性仍未得到证实。
