Anti-beta2-glycoprotein I: prevalence, clinical correlations, and importance of persistent positivity in patients with antiphospholipid syndrome and systemic lupus erythematosus.
Anti-beta2-glycoprotein I: prevalence, clinical correlations, and importance of persistent positivity in patients with antiphospholipid syndrome and systemic lupus erythematosus.
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发表时间：
2006-09
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通讯作者：
Adriana Danowski;T. Kickler;M. Petri
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作者：
Adriana Danowski;T. Kickler;M. Petri
目的在很大一部分原发性或继发性抗磷脂综合征（APS）患者中发现了β 2-糖蛋白I（抗β 2-GPI）抗体。我们的目的是确定这些抗体在APS和系统性红斑狼疮（SLE）患者中的患病率和临床相关性，并与抗心磷脂（ACL）和狼疮抗凝剂（LAC）进行比较。我们调查了连续样本是否提高了临床效用。方法收集2002年10月至2003年3月间连续418例SLE或APS患者的血清样本，检测抗β 2-GPI（IgG、IgM、伊加）、aCL（IgG、IgM、伊加）和LAC（稀释罗素蝰蛇毒时间法; RVVT）。分析这些患者的临床和血清学资料。结果抗β 2-GPI阳性185例（44.5%），aCL阳性55.3%，LAC阳性31.1%。抗β 2-GPI在白人中比在非裔美国人中更常见（p = 0.098）。IgM和伊加是最常见的抗β 2-GPI同种型。aCL和抗β 2-GPI高度相关（p < 0.0001至p = 0.0177，取决于同种型）。通过稀释RVVT和抗β 2-GPI IgG（p < 0.0001）、IgM（p <0.0001）和伊加（p = 0.0002）抗体发现LAC的存在之间存在正相关。持续阳性增加了静脉和动脉血栓形成与抗β 2-GPI（IgG和IgM同种型）的相关性。妊娠丢失、癫痫发作和偏头痛与抗β 2-GPI无关。伊加抗β 2-GPI与APS的任何表现均无显著相关性。结论抗β 2-GPI IgM和伊加在我国人群中的检出率较高。抗β 2-GPI IgG的测量在临床上可用于识别静脉和动脉血栓形成风险较高的SLE患者。持续阳性增加IgG抗β 2-GPI与静脉血栓形成和抗β 2-GPI IgM与动脉血栓形成的相关性。伊加抗β 2-GPI与APS表现无显著相关性。
OBJECTIVE Antibodies to beta2-glycoprotein I (anti-beta2-GPI) are found in a large percentage of patients with primary or secondary antiphospholipid syndrome (APS). Our aim was to identify the prevalence and clinical correlation of these antibodies in patients with APS and systemic lupus erythematosus (SLE), in comparison to anticardiolipin (aCL) and the lupus anticoagulant (LAC). We investigated whether serial samples improve clinical utility. METHODS Serum samples for anti-beta2-GPI (IgG, IgM, IgA), aCL (IgG, IgM, IgA), and LAC (by dilute Russell viper venom time; RVVT) were collected from 418 consecutive patients with SLE or APS between October 2002 and March 2003. Clinical and serologic data of these patients were analyzed. RESULTS A total of 185 (44.5%) patients were positive for anti-beta2-GPI, 55.3% were positive for aCL, and 31.1% for LAC. Anti-beta2-GPI was more common in Caucasians than in African Americans (p = 0.098). IgM and IgA were the most frequent isotypes of anti-beta2-GPI. aCL and anti-beta2-GPI were highly associated (p < 0.0001 to p = 0.0177, depending on isotype). A positive association was found between the presence of the LAC by dilute RVVT and anti-beta2-GPI IgG (p < 0.0001), IgM (p < 0.0001), and IgA (p = 0.0002) antibodies. Persistent positivity increased the association of venous and arterial thrombosis with anti-beta2-GPI (IgG and IgM isotypes). Pregnancy loss, seizures, and migraines were not associated with anti-beta2-GPI. IgA anti-beta2-GPI was not significantly associated with any manifestation of APS. CONCLUSION The prevalence of anti-beta2-GPI IgM and IgA was very high in our population. Measurement of anti-beta2-GPI IgG is clinically useful in identifying patients with SLE at higher risk for venous and arterial thrombosis. Persistent positivity increased the association of IgG anti-beta2-GPI with venous thrombosis and anti-beta2-GPI IgM with arterial thrombosis. IgA anti-beta2-GPI was not significantly associated with APS manifestations.