抗β_2糖蛋白Ⅰ抗体在系统性红斑狼疮患者血栓形成中的作用

Role of Anti-β_2-glycoprotein I Antibodies in Patients with Systemic Lupus Erythematosus Complicated with Thrombosis

目的探讨抗β_2糖蛋白Ⅰ(anti-β_2-glycoprotein I,aβ_2GPI)抗体IgA、IgM、IgG在系统性红斑狼疮(systemic lupus erythematosus,SLE)血栓形成中的作用。方法收集确诊SLE患者,根据有无发生临床血栓事件分为SLE-non-APS组和SLE-APS组。选取原发性抗磷脂抗体综合征为PAPS组。这些患者均经实验室检测为aβ_2GP I抗体阳性,且排除血栓形成的传统危险因素。应用酶联免疫吸附试验检测各组患者aβ_2GPI的IgA、IgM、IgG 3类抗体水平。SLE-APS组+PAPS组患者中发生动脉血栓事件者纳入APS-A组,发生静脉血栓事件者纳入APS-V组,比较两组间上述指标。结果共纳入82例患者,SLE患者64例,原发性APS患者18例(PAPS组)。64例SLE患者中,SLE-non-APS组52例,SLE-APS组12例。SLEAPS组+PAPS组共30例,其中APS-A组23例,APS-V组7例。SLE-APS组aβ_2GPI-IgA[(1.3±0.4)×10^(-8)mol/L]、aβ_2GPI-IgM浓度[(1.0±0.2)×10^(-8)mol/L]低于SLE-non-APS组[aβ_2GPI-IgA:(1.8±0.9)×10^(-8)mol/L,aβ_2GPI-IgM:(1.5±0.7)×10^(-8)mol/L](P<0.05),而两组aβ_2GPI-IgG的浓度无明显差异。SLE-APS组与PAPS组患者aβ_2GPI-IgA、aβ_2GPI-IgG、aβ_2GPI-IgM的浓度无明显差异。APS-A组aβ_2GPI-IgM浓度[(1.2±0.5)×10^(-8)mol/L]显著高于APS-V组[(0.7±0.1)×10^(-8)mol/L](P<0.05),aβ_2GPI-IgG浓度显著低于APS-V组[(1.4±0.3)×10^(-8)mol/L vs.(1.7±0.3)×10^(-8)mol/L](P<0.05),而两组aβ_2GPI-IgA的浓度无明显差异。结论无论有无SLE基础免疫性疾病,IgG类aβ_2GPI与静脉血栓形成有明显的关联性,IgM类aβ_2GPI与动脉血栓形成相关。

Objective To investigate the role of different classes of anti-β2-glycoprotein I antibodies in patients with systemic lupus erythematosus（SLE）complicated with thrombosis.Methods According to the patients who suffered with clinical thrombotic events or not,SLE patients were divided into the SLE-non-APS group and SLE-APS group.While patients with primary antiphospholipid antibody syndrome were included in the PAPS group.All these patients were positive for anti-β2-glycoprotein I antibodies,and traditional risk factors for thrombosis were excluded.Levels of anti-β2 GPI IgA,anti-β2 GPI IgG,anti-β2 GPI IgM,were detected by ELISA assays.In addition,patients in SLE-APS group and PAPS group were separated into two groups：patients suffered with arterial thromboembolic events were included in the APS-A group,patientssuffered with venous thromboembolic events were included in APS-V group.The above parameters between the two groups were compared.Results In Total 82 patients were enrolled including 64 cases with SLE and 18 primary antiphospholipid antibody syndrome（PAPS group）.Of the 64 cases with SLE,52 were furthered included in the SLE-non-APS group and 12 in the SLE-APS group.In total 30 patients were in the SLE-APS group and the PAPS group were composed of 23 cases in the APS-A group and 7 cases in the APS-V group. The anti-β2 GPI IgA [（1.3 ±0.4）×10 -8 mol/L]and anti-β2 GPI IgM [（1.0 ±0.2）×10 -8 mol/L]were with low density in SLE-APS group than that in the SLE-non-APS group [aβ2 GPI-IgA：（1.8 ±0.9）× 10 -8 mol/L,aβ2 GPI-IgM：（1.5 ±0.7 ）×10 -8 mol/L] （P 〈0.05 ）,but there was no significant difference in the concentration of anti-β2 GPI IgG between the SLE-APS group and the SLE-non-APS group. There was no significant difference in the concentration of anti-β2 GPI IgA,anti-β2 GPI IgG,anti-β2 GPI IgM between the SLE-APS group and PAPS group.The APS-A group had a higher concentration of anti-β2 GPI IgM [（1.2 ±0.5）×10 -8 mol/L]than the APS-V group [（0.7 ±0.1）×10 -8 mol/L]（P 〈0.05）,but a lower concentration of anti-β2 GPI IgG [（1.4 ±0.3）×10 -8 mol/L vs.（1.7 ±0.3）×10 -8 mol/L]（P 〈0.05）,but there was no significant difference between the two groups in the concentration of anti-β2 GPI IgA.Conclusion No matter patients are with SLE or not,there is nosigwifieant correlation between anti-β2 GPI IgG and venous thrombosis,but the anti-β2 GPI IgM antibody is significantly correlated with arterial thrombosis.