Day H M, Thiagarajan P, Ahn C, Reveille J D, Tinker K F, Arnett F C
Department of Internal Medicine, University of Texas-Houston Health Science Center, 77030, USA.
J Rheumatol. 1998 Apr;25(4):667-74.
To examine relationships between anti-beta2-glycoprotein (beta2-GPI) antibodies and other antiphospholipid antibody (aPL) tests (aPL ELISA and the lupus anticoagulant or LAC) and the associations of each of these aPL tests with individual clinical manifestations of the antiphospholipid antibody syndrome (APS).
IgG and IgM anti-beta2-GPI antibodies were determined by ELISA in 281 patients with SLE, primary APS, or other connective tissue diseases. Frequencies, sensitivities, specificities, and predictive values and correlations of anti-beta2-GPI were compared to the aPL ELISA (IgG and IgM) and LAC for individual (and combined) features of APS.
Among 139 patients with positive aPL ELISA and/or LAC tests, 57 (41%) had anti-beta2-GPI antibodies (IgG and/or IgM) compared to 11% of patients with SLE negative for these tests (p = 0.00001). In 130 patients with APS, anti-beta2-GPI occurred in 42% and tended to be more specific but less sensitive than the aPL ELISA or LAC. When all 3 aPL tests were combined, the best sensitivities and negative predictive values were achieved; however, specificity and positive predictive values remained low. Anti-beta2-GPI antibodies occurred more frequently in primary APS (58%) vs secondary antiphospholipid syndromes (33%) (p = 0.008, OR = 2.9). Among 79 patients with SLE negative by both aPL ELISA and LAC, 9 (11 %) were positive for anti-beta2-GPI, 7 of whom had clinical features consistent with APS (representing 5% of all with APS). Stepwise multiple logistic regression analysis revealed beta2-GPI to be most strongly associated with neurological syndromes other than stroke, deep venous thrombosis, and recurrent fetal loss, while LAC was most strongly correlated with stroke and thrombocytopenia. IgM aPL antibodies also were independently associated with neurological syndromes and recurrent fetal loss.
Testing for beta2-GPI antibodies may be clinically useful in the diagnosis of APS but cannot supplant other aPL ELISA or LAC. Multivariate analyses suggest that anti-beta2-GPI antibodies may play a more central role in certain clinical manifestations of APS than antibodies detected by the aPL ELISA or LAC.
研究抗β2-糖蛋白（β2-GPI）抗体与其他抗磷脂抗体（aPL）检测（aPL酶联免疫吸附测定和狼疮抗凝物或LAC）之间的关系，以及这些aPL检测中的每一项与抗磷脂抗体综合征（APS）的个体临床表现之间的关联。
采用酶联免疫吸附测定法检测281例系统性红斑狼疮（SLE）、原发性APS或其他结缔组织病患者的IgG和IgM抗β2-GPI抗体。将抗β2-GPI的频率、敏感性、特异性、预测值及相关性与aPL酶联免疫吸附测定（IgG和IgM）及LAC针对APS的个体（及合并）特征进行比较。
在139例aPL酶联免疫吸附测定和/或LAC检测呈阳性的患者中，57例（41%）有抗β2-GPI抗体（IgG和/或IgM），而在这些检测呈阴性的SLE患者中这一比例为11%（p = 0.00001）。在130例APS患者中，抗β2-GPI抗体的出现率为42%，其特异性往往更高，但敏感性低于aPL酶联免疫吸附测定或LAC。当将所有3项aPL检测联合应用时，可获得最佳敏感性和阴性预测值；然而，特异性和阳性预测值仍然较低。抗β2-GPI抗体在原发性APS（58%）中比继发性抗磷脂综合征（33%）中出现得更频繁（p = 0.008，比值比 = 2.9）。在79例aPL酶联免疫吸附测定和LAC均为阴性的SLE患者中，9例（11%）抗β2-GPI呈阳性，其中7例具有与APS一致的临床特征（占所有APS患者的5%）。逐步多元逻辑回归分析显示，β2-GPI与除中风、深静脉血栓形成和复发性流产之外的神经综合征关联最为密切，而LAC与中风和血小板减少症关联最为密切。IgM aPL抗体也与神经综合征和复发性流产独立相关。
检测β2-GPI抗体在APS诊断中可能具有临床意义，但不能替代其他aPL酶联免疫吸附测定或LAC。多变量分析表明，抗β2-GPI抗体在APS的某些临床表现中可能比aPL酶联免疫吸附测定或LAC检测到的抗体发挥更核心的作用。
