Antiphospholipid antibody profiles in lupus nephritis with glomerular microthrombosis: a prospective study of 124 cases.
Antiphospholipid antibody profiles in lupus nephritis with glomerular microthrombosis: a prospective study of 124 cases.
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狼疮性肾炎伴肾小球微血栓形成的抗磷脂抗体谱：124例的前瞻性研究
DOI：
10.1186/ar2736
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发表时间：
2009
影响因子：
4.9
通讯作者：
Yang CD
中科院分区：
文献类型：
--
作者：
Zheng H;Chen Y;Ao W;Shen Y;Chen XW;Dai M;Wang XD;Yan YC;Yang CD
简介肾小球微血栓（GMT）是狼疮性肾炎（LN）患者常见的血管变化。 GMT 的基本机制尚不清楚。尽管一些研究报道了抗磷脂抗体（aPL）与 GMT 的关联，但 GMT 和 aPL 之间的关系仍然存在争议。先前的研究表明，一些 aPL 可以与几种具有同源酶结构域的止血和纤溶蛋白酶结合。蛋白酶反应性aPL中，有的能抑制活化蛋白C的抗凝活性和纤溶酶的纤溶功能，并阻碍凝血酶的抗凝血酶失活。本研究的目的是调查 LN 患者中 GMT 的患病率，并检查 aPL 谱（包括一些蛋白酶反应性 aPL）与 GMT 之间的关系。方法检查肾活检标本是否存在肾小球微血栓。对 25 例有 GMT 的 LN 患者（LN-GMT 组）和 99 例无 GMT 的 LN 患者（LN-非 GMT 组）的血浆样本进行狼疮抗凝物和抗心磷脂、β2 糖蛋白 I、纤溶酶、凝血酶、组织纤溶酶原激活剂和膜联蛋白 II 抗体的检测。结果 LN 患者中 GMT 的患病率为 20.2%。与LN-non-GMT组相比，LN-GMT组的系统性红斑狼疮疾病活动指数升高；肾组织损伤活动度和慢性指数升高；血清肌酐、血尿素氮和蛋白尿水平升高；血清 C3 水平较低，肾小球 C3、C1q 染色更强烈；高血压的发生率较高（P < 0.05）。此外，LN-GMT组狼疮抗凝物、免疫球蛋白G（IgG）抗β2糖蛋白I和抗凝血酶抗体的检出率高于LN-非GMT组（均P<0.05）。抗心磷脂IgG、纤溶酶、组织纤溶酶原激活物、膜联蛋白II抗体检出率差异无统计学意义（均P>0.05）。两组之间针对上述抗原的IgM自身抗体没有观察到可检测到的差异。结论GMT发生在大约20.2%的LN患者中。与无GMT的患者相比，有GMT的患者肾组织损伤更严重，肾功能更差。狼疮抗凝剂、抗 β2 糖蛋白 I 和凝血酶的抗体可能在 GMT 中发挥作用。
IntroductionGlomerular microthrombosis (GMT) is a common vascular change in patients with lupus nephritis (LN). The mechanism underlying GMT is largely unknown. Although several studies have reported the association of antiphospholipid antibodies (aPL) with GMT, the relation between GMT and aPL remains controversial. Previous studies have demonstrated that some aPL could bind to several hemostatic and fibrinolytic proteases that share homologous enzymatic domains. Of the protease-reactive aPL, some can inhibit the anticoagulant activity of activated protein C and the fibrinolytic function of plasmin, and hinder the antithrombin inactivation of thrombin. The purpose of this study was to investigate the prevalence of GMT in LN patients and examine the relation between the aPL profiles (including some protease-reactive aPL) and GMT.MethodsRenal biopsy specimens were examined for the presence of glomerular microthrombi. Plasma samples from 25 LN patients with GMT (LN-GMT group) and 99 LN patients without GMT (LN-non-GMT group) were tested for lupus anticoagulant and antibodies against cardiolipin, β2 glycoprotein I, plasmin, thrombin, tissue plasminogen activator, and annexin II.ResultsThe prevalence of GMT in LN patients was 20.2%. Compared with the LN-non-GMT group, the LN-GMT group had an elevated systemic lupus erythematosus disease activity index; elevated renal tissue injury activity and chronicity indices; elevated serum creatinine, blood urea nitrogen, and proteinuria levels; a lower serum C3 level and much intense glomerular C3, C1q staining; and a higher frequency of hypertension (P< 0.05 for all). Additionally, the detection rate of lupus anticoagulant, immunoglobulin G (IgG) anti-β2 glycoprotein I and anti-thrombin antibodies were higher in the LN-GMT group than in the LN-non-GMT group (P< 0.05 for all). No statistical differences were found in the detection rates of IgG anti-cardiolipin, plasmin, tissue plasminogen activator, or annexin II antibodies (P> 0.05 for all). No detectable difference in IgM autoantibodies to the above antigens was observed between the two groups.ConclusionsGMT occurs in approximately 20.2% of LN patients. Patients with GMT have severer renal tissue injuries and poorer renal functions than patients without GMT. The lupus anticoagulant and antibodies against β2 glycoprotein I and thrombin may play a role in GMT.
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影响因子：
13.2
作者：
FARRUGIA, E;TORRES, VE;HOLLEY, KE
通讯作者：
HOLLEY, KE
影响因子：
3
作者：
Fialová, L;Zima, T;Certíková, V
通讯作者：
Certíková, V
影响因子：
6.1
作者：
KLEINKNECHT, D;BOBRIE, G;RAMDANE, M
通讯作者：
RAMDANE, M
影响因子：
13.3
作者：
Griffiths, MH;Papadaki, L;Neild, GH
通讯作者：
Neild, GH
影响因子：
2.6
作者：
D'Cruz, DP
通讯作者：
D'Cruz, DP