系统性红斑狼疮患者中IgA抗β2-糖蛋白I抗体异常水平的高频率：与抗磷脂综合征的关系。

High frequency of abnormal levels of IgA anti-beta2-glycoprotein I antibodies in patients with systemic lupus erythematosus: relationship with antiphospholipid syndrome.

作者信息

Fanopoulos D, Teodorescu M R, Varga J, Teodorescu M

机构信息

Department of Microbiology/Immunology, University of Illinois at Chicago, 60612, USA.

出版信息

J Rheumatol. 1998 Apr;25(4):675-80.

PMID:9558168

Abstract

OBJECTIVE

To determine the frequency of IgA, in addition to IgM and IgG, anti-beta2-GPI and anticardiolipin (aCL) antibodies in patients with systemic lupus erythematosus (SLE), and to relate the presence of these antibodies to symptoms of antiphospholipid antibody syndrome (APS).

METHODS

Sera from 100 blood bank donors (controls) and 48 patients with SLE were tested by ELISA. The same enzyme conjugates were used in the measurement of aCL and anti-beta2-GPI. Medical records were reviewed for the presence of manifestations of APS: arterial occlusion, pulmonary embolism, cerebrovascular accident, transient ischemic attack, venous thrombosis (deep or superficial), hemolytic anemia, thrombocytopenia, repeated fetal loss, leg ulcers, seizures, avascular bone necrosis, cerebritis, or migraine.

RESULTS

Above normal levels of antibodies of all 3 isotypes against beta2-GPI were found in 5% of controls and 73% of patients with SLE. Antibodies against cardiolipin in the 2 groups were found in 5 and 37%, respectively. IgA anti-beta2-GPI was found in 2% of controls and 58% of patients with SLE; in contrast, only 2% of patients with SLE had IgA aCL. In the 48 patients studied, thrombosis and fetal loss were present in 10 (Group 1), other manifestations of APS were present in 18 (Group 2), and none in 20 (Group 3). Antibodies to beta2-GPI of all 3 isotypes were found in a higher proportion of APS (Group 1 plus Group 2) (82%) than in Group 3 (50%) (p < 0.01, chi-squared). There was also a significantly higher proportion of patients with elevated anti-beta2-GPI in Group 1 (90%) than in Group 3 (p < 0.02). There was a significantly higher frequency (p < 0.01) and level (p < 0.05) of IgA anti-beta2-GPI in patients with APS than in those with no APS manifestations. Moreover, compared to aCL and with other isotypes of anti-beta2-GPI, the highest antibody levels were observed in IgA antibeta2-GPI.

CONCLUSION

The sensitivity of the anti-beta2-GPI antibody test for APS in patients with SLE is significantly increased by measuring IgA, in addition to IgM and IgG isotype.

摘要

目的

确定系统性红斑狼疮（SLE）患者中除IgM和IgG外，抗β2 -糖蛋白I（β2 -GPI）和抗心磷脂（aCL）抗体中IgA的频率，并将这些抗体的存在与抗磷脂抗体综合征（APS）的症状相关联。

方法

采用酶联免疫吸附测定（ELISA）法检测100名血库供血者（对照组）和48名SLE患者的血清。在测定aCL和抗β2 -GPI时使用相同的酶结合物。查阅病历以确定APS的表现：动脉闭塞、肺栓塞、脑血管意外、短暂性脑缺血发作、静脉血栓形成（深静脉或浅静脉）、溶血性贫血、血小板减少、反复流产、腿部溃疡、癫痫发作、无菌性骨坏死、脑炎或偏头痛。

结果

在5%的对照组和73%的SLE患者中发现所有3种免疫球蛋白同型针对β2 -GPI的抗体水平高于正常。两组中抗心磷脂抗体的检出率分别为5%和37%。IgA抗β2 -GPI在2%的对照组和58%的SLE患者中被发现；相比之下，只有2%的SLE患者有IgA aCL。在研究的48例患者中，10例（第1组）出现血栓形成和流产，18例（第2组）出现APS的其他表现，20例（第3组）无上述表现。与第3组（50%）相比，所有3种免疫球蛋白同型针对β2 -GPI的抗体在APS患者（第1组加第2组）中的比例更高（82%）（p<0.01，卡方检验）。第1组中抗β2 -GPI升高的患者比例（90%）也显著高于第3组（p<0.02）。与无APS表现的患者相比，APS患者中IgA抗β2 -GPI的频率（p<0.01）和水平（p<0.05）显著更高。此外，与aCL和抗β2 -GPI的其他免疫球蛋白同型相比，IgA抗β2 -GPI中的抗体水平最高。