中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2014年
8期
597-602
,共6页
红斑狼疮,系统性%抗磷脂综合征%免疫球蛋白类%抗体,抗心磷脂%β2糖蛋白Ⅰ%狼疮凝固抑制物
紅斑狼瘡,繫統性%抗燐脂綜閤徵%免疫毬蛋白類%抗體,抗心燐脂%β2糖蛋白Ⅰ%狼瘡凝固抑製物
홍반랑창,계통성%항린지종합정%면역구단백류%항체,항심린지%β2당단백Ⅰ%랑창응고억제물
Lupus erythematosus,systemic%Antiphospholipid syndrome%Immunoglobulins%Antibodies,anticardiolipin%beta 2-Glycoprotein Ⅰ%Lupus coagulation inhibitor
目的 探讨不同亚型(IgG、IgM和IgA型)抗心磷脂抗体(aCL)和抗β2糖蛋白1抗体(抗β2GP1抗体),以及狼疮抗凝物(LA)在系统性红斑狼疮(SLE)诊断中的价值.方法 病例对照研究.2012年1月至2013年9月在北京协和医院风湿免疫科确诊为SLE的患者共100例(其中42例确诊为继发性抗磷脂综合征,SAPS),44名健康对照者和32例除外SLE和抗磷脂抗体综合征(APS)的其他结缔组织病患者采用酶联免疫吸附法(ELISA)分别用IgA/G/M多亚型筛选试剂和IgA、IgG、IgM单亚型试剂检测aCL和抗β2GP1抗体,采用改良的稀释蝰蛇毒磷脂时间(dRVVT)检测狼疮抗凝物(LA),并回顾分析SLE患者中抗磷脂抗体与APS临床表现的相关性.采用x2检验比较SLE组、健康对照组及其他结缔组织疾病组中抗磷脂抗体的阳性率,不同组间抗体浓度分布的比较采用独立样本Kruskal-Wallis检验.抗磷脂抗体与APS临床表现的相关性采用Spearman相关分析.在SLE组患者中,以APS的临床诊断作为金标准,采用四格表统计抗磷脂抗体对APS的诊断效能.结果 SLE组中IgG型aCL(x2=15.031,P＜0.001),IgA/G/M型(x2=11.678,P =0.003)和IgA型(x2 =6.17,P =0.036)抗β2GP1抗体的阳性率高于健康对照组和疾病对照组,差异有统计学意义.IgA/G/M型(r=0.207,P=0.039),IgG(r=0.230,P=0.021)和IgA型(r=0.217,P=0.030) aCL,IgA/G/M型(r=0.218,P=0.029)和IgA型(r=0.255,P=0.叭)抗β2GP1抗体,及LA(r =0.233,P =0.02)与血栓事件相关.IgA/G/M型抗β2GP1抗体(r=0.22,P=0.029)和LA(r=0.254,P=0.011)与病态妊娠相关.aCL阳性的SLE患者中,23.1％ (6/26)仅IgM和/或IgA亚型阳性;抗β2GP1抗体阳性的SLE患者中,53.6％(15/28)仅IgM和/或IgA亚型阳性.在SLE患者中,IgA/G/M型aCL对APS的特异度和敏感度分别为98.3％和26.2％,IgA/G/M型抗β2GP1抗体对APS的特异度和敏感度分别为84.5％和40.5％.当2种以上抗体亚型阳性时,aCL和抗p2GP1抗体对APS的特异度高于仅检测IgG型aCL(98.3％/94.8％)和抗p2GP1抗体(98.3％/93.1％).当任意一项亚型项阳性时,aCL和抗β2GP1抗体对APS的敏感度高于仅检测IgG型aCL(47.6％/40.5％)和抗β2GP1抗体(42.9％/21.4％).结论 IgA/G/M多克隆试剂筛查aCL对于APS的敏感度较低,建议初筛时应同时检测IgG型和IgM型aCL.多克隆IgA/G/M型抗β2GP1抗体对于APS的敏感度较高,并与血栓和病态妊娠显著相关,建议采用IgA/G/M多亚型抗β2GP1抗体作为初筛,初筛阳性患者再进一步确认抗体亚型.IgA型抗磷脂抗体与血栓事件相关,在IgG和IgM型抗体阴性时检测IgA型抗体有助于APS疑似患者的诊断.
目的 探討不同亞型(IgG、IgM和IgA型)抗心燐脂抗體(aCL)和抗β2糖蛋白1抗體(抗β2GP1抗體),以及狼瘡抗凝物(LA)在繫統性紅斑狼瘡(SLE)診斷中的價值.方法 病例對照研究.2012年1月至2013年9月在北京協和醫院風濕免疫科確診為SLE的患者共100例(其中42例確診為繼髮性抗燐脂綜閤徵,SAPS),44名健康對照者和32例除外SLE和抗燐脂抗體綜閤徵(APS)的其他結締組織病患者採用酶聯免疫吸附法(ELISA)分彆用IgA/G/M多亞型篩選試劑和IgA、IgG、IgM單亞型試劑檢測aCL和抗β2GP1抗體,採用改良的稀釋蝰蛇毒燐脂時間(dRVVT)檢測狼瘡抗凝物(LA),併迴顧分析SLE患者中抗燐脂抗體與APS臨床錶現的相關性.採用x2檢驗比較SLE組、健康對照組及其他結締組織疾病組中抗燐脂抗體的暘性率,不同組間抗體濃度分佈的比較採用獨立樣本Kruskal-Wallis檢驗.抗燐脂抗體與APS臨床錶現的相關性採用Spearman相關分析.在SLE組患者中,以APS的臨床診斷作為金標準,採用四格錶統計抗燐脂抗體對APS的診斷效能.結果 SLE組中IgG型aCL(x2=15.031,P＜0.001),IgA/G/M型(x2=11.678,P =0.003)和IgA型(x2 =6.17,P =0.036)抗β2GP1抗體的暘性率高于健康對照組和疾病對照組,差異有統計學意義.IgA/G/M型(r=0.207,P=0.039),IgG(r=0.230,P=0.021)和IgA型(r=0.217,P=0.030) aCL,IgA/G/M型(r=0.218,P=0.029)和IgA型(r=0.255,P=0.叭)抗β2GP1抗體,及LA(r =0.233,P =0.02)與血栓事件相關.IgA/G/M型抗β2GP1抗體(r=0.22,P=0.029)和LA(r=0.254,P=0.011)與病態妊娠相關.aCL暘性的SLE患者中,23.1％ (6/26)僅IgM和/或IgA亞型暘性;抗β2GP1抗體暘性的SLE患者中,53.6％(15/28)僅IgM和/或IgA亞型暘性.在SLE患者中,IgA/G/M型aCL對APS的特異度和敏感度分彆為98.3％和26.2％,IgA/G/M型抗β2GP1抗體對APS的特異度和敏感度分彆為84.5％和40.5％.噹2種以上抗體亞型暘性時,aCL和抗p2GP1抗體對APS的特異度高于僅檢測IgG型aCL(98.3％/94.8％)和抗p2GP1抗體(98.3％/93.1％).噹任意一項亞型項暘性時,aCL和抗β2GP1抗體對APS的敏感度高于僅檢測IgG型aCL(47.6％/40.5％)和抗β2GP1抗體(42.9％/21.4％).結論 IgA/G/M多剋隆試劑篩查aCL對于APS的敏感度較低,建議初篩時應同時檢測IgG型和IgM型aCL.多剋隆IgA/G/M型抗β2GP1抗體對于APS的敏感度較高,併與血栓和病態妊娠顯著相關,建議採用IgA/G/M多亞型抗β2GP1抗體作為初篩,初篩暘性患者再進一步確認抗體亞型.IgA型抗燐脂抗體與血栓事件相關,在IgG和IgM型抗體陰性時檢測IgA型抗體有助于APS疑似患者的診斷.
목적 탐토불동아형(IgG、IgM화IgA형)항심린지항체(aCL)화항β2당단백1항체(항β2GP1항체),이급랑창항응물(LA)재계통성홍반랑창(SLE)진단중적개치.방법 병례대조연구.2012년1월지2013년9월재북경협화의원풍습면역과학진위SLE적환자공100례(기중42례학진위계발성항린지종합정,SAPS),44명건강대조자화32례제외SLE화항린지항체종합정(APS)적기타결체조직병환자채용매련면역흡부법(ELISA)분별용IgA/G/M다아형사선시제화IgA、IgG、IgM단아형시제검측aCL화항β2GP1항체,채용개량적희석호사독린지시간(dRVVT)검측랑창항응물(LA),병회고분석SLE환자중항린지항체여APS림상표현적상관성.채용x2검험비교SLE조、건강대조조급기타결체조직질병조중항린지항체적양성솔,불동조간항체농도분포적비교채용독립양본Kruskal-Wallis검험.항린지항체여APS림상표현적상관성채용Spearman상관분석.재SLE조환자중,이APS적림상진단작위금표준,채용사격표통계항린지항체대APS적진단효능.결과 SLE조중IgG형aCL(x2=15.031,P＜0.001),IgA/G/M형(x2=11.678,P =0.003)화IgA형(x2 =6.17,P =0.036)항β2GP1항체적양성솔고우건강대조조화질병대조조,차이유통계학의의.IgA/G/M형(r=0.207,P=0.039),IgG(r=0.230,P=0.021)화IgA형(r=0.217,P=0.030) aCL,IgA/G/M형(r=0.218,P=0.029)화IgA형(r=0.255,P=0.팔)항β2GP1항체,급LA(r =0.233,P =0.02)여혈전사건상관.IgA/G/M형항β2GP1항체(r=0.22,P=0.029)화LA(r=0.254,P=0.011)여병태임신상관.aCL양성적SLE환자중,23.1％ (6/26)부IgM화/혹IgA아형양성;항β2GP1항체양성적SLE환자중,53.6％(15/28)부IgM화/혹IgA아형양성.재SLE환자중,IgA/G/M형aCL대APS적특이도화민감도분별위98.3％화26.2％,IgA/G/M형항β2GP1항체대APS적특이도화민감도분별위84.5％화40.5％.당2충이상항체아형양성시,aCL화항p2GP1항체대APS적특이도고우부검측IgG형aCL(98.3％/94.8％)화항p2GP1항체(98.3％/93.1％).당임의일항아형항양성시,aCL화항β2GP1항체대APS적민감도고우부검측IgG형aCL(47.6％/40.5％)화항β2GP1항체(42.9％/21.4％).결론 IgA/G/M다극륭시제사사aCL대우APS적민감도교저,건의초사시응동시검측IgG형화IgM형aCL.다극륭IgA/G/M형항β2GP1항체대우APS적민감도교고,병여혈전화병태임신현저상관,건의채용IgA/G/M다아형항β2GP1항체작위초사,초사양성환자재진일보학인항체아형.IgA형항린지항체여혈전사건상관,재IgG화IgM형항체음성시검측IgA형항체유조우APS의사환자적진단.
Objective To investigate the prevalence and clinical significance of different subtypes (IgG,IgM and IgA) of anticardiolipin antibodies (aCL) and anti-β2-glycoprotein Ⅰ antibodies (aβ 2GP1),as well as lupus anticoagulant (LA) in systemic lupus erythematosus (SLE).Methods IgG/IgM/IgA,IgG,IgM,IgA aCL and anti-β2GP1 were tested by enzyme-linked immunosorbent assay (ELISA) in 100 patients with SLE (42 patients were diagnosed as secondary antiphospholipid syndrome),44 healthy controls and 32 patients with other connective tissue diseases excluding SLE and antiphospholipid syndrome (APS).Meanwhile,LA was tested by modified Dilute Russell's viper venom time (dRVVT).The correlation between antiphospholipid antibodies and clinical manifestation was analyzed by Spearman correlation analysis.The postiverate of antiphospholipid antibodies in SLE patients,health controls and patients with other connective tissue diseases were compared by chi square test.The concentrations of antiphospholipid antibodies in different groups were compared using independent sample Kruskal Wallis test.The diagnostic efficacy of antiphospholipid antibodies in SLE patients was analyzed by crosstable using clinical diagnosis of APS as gold standard.P ＜ 0.05 was considered statistically significant.Results The prevalence of IgG aCL (x2 =15.031,P ＜ 0.001),IgA/G/M (x2 =11.678,P =0.003) and IgA (x2 =6.17,P =0.036) antiβ2GP1 were significantly higher in patients with SLE than in the other two groups.IgA/G/M (r =0.207,P=0.039),IgG (r=0.230,P=0.021) and IgA (r=0.217,P=0.030) aCL,IgA/G/M (r=0.218,P=0.029) and IgA (r =0.255,P =0.01) anti-β2GP1,as well as LA (r =0.233,P =0.02) were associated with thrombotic events.IgA/G/M anti-β2GP1 (r =0.22,P =0.029) and LA (r =0.254,P =0.011) were associated with pathological pregnancy.23.1％ (6/26) aCL positive SLE patients were IgM and/or IgA aCL positive.53.6％ (15/28) anti-β2GP1 positive SLE patients were IgM and/or IgA antiβ2GP1 positive.In SLE patients,the specificity and sensitivity of IgA/G/M aCL for APS were 98.3％ and 26.2％,respectively.The specificity and sensitivity of IgA/G/M anti-β2GP1 were 84.5％ and 40.5％,respectively.The specificity of at least two isotypes positive for APS (both aCL and anti-β2GP1 were 98.3％),was higher than IgG aCL (94.8％) or anti-β2GP1 (93.1％).The sensitivity of at least one isotype of aCL (47.6％) or anti-β2GP1 (42.9％) positive for APS were higher than IgG aCL (40.5％)and anti-β2GP1 (21.4％).Conclusions IgG and IgM aCL together would be better than IgA/G/M aCL for APS screening.IgA/G/M anti-β2GP1 would be better for APS screen due to higher sensitivity and strong association with thromboembolic events and pathologic pregnance.IgA aCL or anti-β2GP1 was associated with thromboembolic events.IgA aCL or anti-β2GP1 would be useful for APS diagnosis in IgG and IgM aCL or anti-β2GPl negative patients.
