非标准抗磷脂抗体对抗磷脂综合征的临床应用价值

Diagnostic value of non-criteria antibodies for antiphospholipid syndrome

目的探讨抗磷脂酰胆碱抗体(aPC)、抗磷脂酰甘油抗体(aPG)和抗鞘磷脂抗体(aSM)检测在抗磷脂综合征(APS)的临床应用价值。方法共纳入98例原发性APS患者(PAPS组),41例继发性APS患者(SAPS组),138例系统性红斑狼疮患者(SLE组)和55例健康体检者(HC组)。采用化学发光免疫试验(CLIA)检测血清抗心磷脂抗体(aCL)、抗β_(2)糖蛋白I抗体(aβ_(2)GPI);酶联免疫吸附试验(ELISA)检测aPC、aPG和aSM。比较分析组间各指标的差异以及其与临床表现的相关性。结果PAPS组的aPC IgM(1.47 U/mL)、aPG IgM(1.82 U/mL)、aSM IgM(20.97 U/mL)、aPG IgG(1.22 U/mL)、aSM IgG(14.56 U/mL)浓度高于SLE组(0.91、0.67、10.83、0.88、9.54 U/mL),差异有统计学意义(均P<0.05);SAPS组aPC IgM(2.00 U/mL)、aPG IgM(1.59 U/mL)、aSM IgM(17.29 U/mL)、aPC IgG(3.30 U/mL)、aPG IgG(2.81 U/mL)浓度较SLE组高(0.91、0.67、10.83、1.42、0.88 U/mL),差异有统计学意义(均P<0.05);PAPS组aPC IgG(1.39 U/mL)、aPC IgM(1.47 U/mL)、aPG IgG(1.22 U/mL)、aPG IgM(1.82 U/mL)和aSM IgG(14.56 U/mL)浓度高于HC组(0.44、0.70、0.57、0.64和6.22 U/mL),差异有统计学意义(均P=0);SAPS组aPC IgG(3.30 U/mL)、aPC IgM(2.00 U/mL)、aPG IgG(2.81 U/mL)、aPG IgM(1.59 U/mL)和aSM IgG(9.84 U/mL)浓度均较HC组高,差异有统计学意义(均P<0.05)。非标准aPLs在APS患者的阳性率分别为IgG/M aPC 23.00%,IgG/M aPG 25.90%,IgG/M aSM 61.20%。aPC IgG和aPG IgG与卒中事件(均P=0.009)、子痫前期早产(P=0.034和P=0.021)相关;aPG IgG与血小板减少(P=0.025)相关;aPC IgM和aPG IgM与溶血性贫血相关(P=0.008和P=0.004);IgG型和IgM型aSM与病态妊娠相关(P=0.012和P=0.018);aCL IgA和aβ_(2)GPI IgA与子痫前期早产相关(P=0.007和P=0.006)。结论增加aCL IgA、aβ_(2)GPI IgA、aPC IgG/M、aPG IgG/M/A和aSM IgG/M检测不能进一步提高APS的实验室诊断价值,但是非标准aPLs与卒中、子痫前期早产、血小板减少等临床症状密切相关。

Objective To investigate the clinical application value of antiphosphatidylcholine(aPC),antiphosphatidylglycerol(aPG),and antisphingomyelin(aSM)for antiphospholipid syndrome(APS).Methods Ninety-eight patients with primary APS(PAPS),41 patients with secondary APS(SAPS),138 patients with SLE,and 55 healthy people were enrolled.Anticardiolipin antibodies(aCL)and anti-β_(2) glycoprotein I antibodies(aβ_(2) GPI)were detected by chemiluminescent immunoassay.aPC,aPG,and aSM were detected by ELISA.The differences in indicators between groups,and the correlation with clinical manifestations was analyzed.Results The concentrations of IgM aPC(1.47 U mL),IgM aPG(1.82 U mL),IgM aSM(20.97 U mL),IgG aPG(1.22 U mL),and IgG aSM(14.56 U mL)in PAPS were higher than those in SLE(0.91,0.67,10.83,0.88,and 9.54 U mL,respectively)(P<0.05).The concentrations of IgM aPC(2.00 U mL),IgM aPG(1.59 U mL),IgM aSM(17.29 U mL),IgG aPC(3.30 U mL),and IgG aPG(2.81 U mL)in SAPS were higher than those in SLE(0.91,0.67,10.83,1.42,and 0.88 U mL,respectively)(P<0.05).As well,the concentrations of IgG aPC(1.39 U mL),IgM aPC(1.47 U mL),IgG aPG(1.22 U mL),IgM aPG(1.82 U mL),and IgG aSM(14.56 U mL)in PAPS were higher than those in healthy people(0.44,0.70,0.57,0.64,and 6.22 U mL,respectively)(P=0.000).The concentrations of IgG aPC(3.30 U mL),IgM aPC(2.00 U mL),IgG aPG(2.81 U mL),IgM aPG(1.59 U mL),and IgG aSM(9.84 U mL)in SAPS were higher than those in healthy people(P<0.05).In the APS patients,the positive rate of IgG M aPC,IgG M aPG,and IgG M aSM was 23.00%,25.90%,and 61.20%,respectively.IgG aPC was associated with stroke,preeclampsia premature birth,and APS nephropathy(P=0.009,0.034,and 0.021,respectively).IgG aPG was associated with thrombocytopenia(P<0.05).IgM aPC and IgM aPG were associated with hemolytic anemia(P<0.05).IgG aSM and IgM aSM were associated with abnormal pregnancy(P<0.05).Conclusion Based on the existing serological markers,testing aCL IgA,aβ_(2)GPI IgA,aPC IgG M,aPG IgG M A,and aSM IgG M cannot further improve the predictive value of APS.However,non-standard aPLs are associated with clinical manifestations of APS,including stroke,preeclampsia premature birth,and thrombocytopenia.