磷脂抗体综合征狼疮抗凝物和血栓临床相关性分析

Clinical correlation analysis between lupus anticoagulant and thrombosis in APS

目的了解抗磷脂抗体(antiphospholipid antibody,APA)包括狼疮抗凝物(lupus anticoagulant,LA),抗心磷脂抗体(anticardilipin antibody,ACL)和β2-糖蛋白Ⅰ(β2-glycoproteinⅠ,β2-GPI)对血栓发生的预测意义,及LA在磷脂抗体综合征(antiphospholipid syndrome,APS)患者中,对治疗后血栓好转的预测意义。方法采用血浆蝰蛇毒时间(dilution viper venom time assay,DRVVT)和活化的部分凝血活酶时间(activated partial thromboplastin time,APTT)进行LA的初筛,纠正和确诊试验;采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定ACL和β2-GPI。结果以LA缩短10 s定为转阴,共22例,5例未转阴,有效率77.3%。20例患者血栓好转,占90.9%(20/22),其中,LA阴转组血栓好转16例,好转率94.1%,LA未阴转组血栓好转4例,好转率80%。两者对比具有显著性差异(P<0.05)。结论LA不仅可以预测血栓的发生,还可预测治疗后血栓的好转情况,有很重要的临床意义。

Objective To know the predictive significance of antiphospholipid antibody （APA） including lupus anticoagulant（ LA）, anticardilipin antibody（ACL） and β2-glyeoprotein I （132- GPI） in thromboembolism and especially research the predictive significance of LA for thrombo- sis relievation before or after treatment in patients who was diagnosed as antipospholipid syn- drome（APS）. Methods Dilution viper venom time assay （DRVVT） and activated partial thromboplastin time （AFFF） were adopted to exert screening, corrective and confirmatory test of LA. ELISA was used to test ACL and β2-GPI. Results If LA shorten 10 seconds or more, it was defined as negativity. Among the 22 cases, 17 became negative and 5 did not. The neg- ativity rate was 77.3 %. Twenty patients whose thromboembolism improved, the improvement rate was 90. 9%. In the negativity group, 16 cases （94. 1% ） whose thrombosis bettered, in non-negativity group, 4 cases （ 80% ） whose thrombus improved. There was significant difference of improvement rate of thrombosis between the LA-negativity group and non-negativity group （P 〈 0. 05 ）. Conclusion LA can not only predict the occurrence of thrombosis, but al- so predict thrombosis improvement after treatment. It has very important clinical significance.