Autoantibodies against EPCR are found in antiphospholipid syndrome and are a risk factor for fetal death
Autoantibodies against EPCR are found in antiphospholipid syndrome and are a risk factor for fetal death
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DOI：
10.1182/blood-2004-03-0793
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发表时间：
2004-09-01
期刊：
影响因子：
20.3
通讯作者：
Hermida, J
中科院分区：
文献类型：
--
作者：
Hurtado, V;Montes, R;Hermida, J
抗磷脂综合征（APS）与血栓形成和胎儿死亡有关，但其病理机制尚不清楚。由于内皮蛋白C受体（EPCR）在抗凝系统和胎盘发育中起作用，我们假设抗EPCR自身抗体可能参与AIRS的临床表现和胎儿丢失。采用酶联免疫吸附试验（ELISA）检测43例APS患者和43例对照组的免疫球蛋白M（IgM）和IgG抗EPCR自身抗体水平。APS患者的抗EPCR水平高于对照组。有趣的是，IgM抗EPCR自身抗体之一抑制内皮细胞上活化蛋白C的产生。由于在胎儿死亡的妇女中发现了显着高的抗EPCR水平，随后分析了87例首次发生不明原因胎儿死亡的患者，并将其抗EPCR水平与87例匹配的对照组进行了比较。我们发现，抗EPCR自身抗体构成了第一次胎儿死亡事件的独立危险因素：抗EPCR自身抗体高于第95百分位数的校正比值比（OR）为IgM 23.0（95%置信区间[CI]，2.0-266.3）和IgG 6.8（95% CI，1.2-38.4）。抗EPCR自身抗体可在APS患者中检测到，是胎儿死亡的独立危险因素。(C)2004年，美国血液学会。
The antiphospholipid syndrome (APS) is associated with thrombosis and fetal death but the pathologic mechanisms are poorly understood. Since endothelial protein C receptor (EPCR) plays a role in the anticoagulant system and in placental development, we hypothesized that anti-EPCR autoantibodies may be involved in clinical manifestations of AIRS and in fetal loss. The levels of immunoglobulin M (IgM) and IgG anti-EPCR autoantibodies were analyzed by enzyme-linked immunosorbent assay (ELISA) in 43 patients with APS and 43 controls. Anti-EPCR levels were higher in APS patients than in controls. Interestingly, one of the IgM anti-EPCR autoantibodies inhibited the generation of activated protein C on endothelium. Since markedly high anti-EPCR levels were found in women with fetal death, 87 patients with a first episode of unexplained fetal death were subsequently analyzed and their anti-EPCR levels were compared with 87 matched controls. We found that anti-EPCR autoantibodies constitute an independent risk factor for a first fetal death episode: the adjusted odds ratios (ORs) for anti-EPCR autoantibodies above the 95th percentile were 23.0 (95% confidence interval [CI], 2.0-266.3) for IgM and 6.8 (95% CI, 1.2-38.4) for IgG. Anti-EPCR autoantibodles can be detected in APS patients and are independent risk factors for fetal death. (C) 2004 by The American Society of Hematology.