More on: criteria to define the antiphospholipid syndrome
More on: criteria to define the antiphospholipid syndrome
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更多信息：定义抗磷脂综合征的标准
DOI：
10.1111/j.1538-7836.2008.02960.x
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发表时间：
2008
影响因子：
10.4
通讯作者：
A. Tripodi
中科院分区：
文献类型：
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作者：
A. Tripodi
转折点这在LA阴性的患者中尤其如此，在这些患者中发现与ab 2GPI ELISA中获得的同种型相同的中/高水平aCL抗体可以加强APS的怀疑。因此，直到产生新的、更特异性的测定，例如特异于致病性ab 2GPI抗体的凝血试验或针对b2 GPI结构域I的候选致病性抗体的ELISA，应继续测定aCL抗体。最后，虽然我们确实知道所有三种测试中的阳性显示与APS中的临床事件非常显著的相关性，但我们不知道单独的阳性ab 2GPI抗体与临床事件有什么关系[4]。在任何情况下，aCL值都作为测试抗体的质量和实验室中ab 2GPI ELISA性能的对照。事实上，当从患有APS的高风险患者中纯化ab 2GPI时，它们在ab 2GPI和aCL ELISA中均产生阳性结果[5]。就IgM同种型而言，大多数答复者（13人中有8人）认为，将其从标准中删除还为时过早。尽管如此，在文献中几乎没有证据表明IgM同种型与血栓栓塞或妊娠丢失相关，许多研究报告称没有相关性。我个人赞成从APS标准中删除IgM同种型，并将其限制在特殊情况下使用，例如在aCL和ab 2GPI ELISA中阳性LA与阳性IgG同种型无关的情况。
turning point. This is especially true in patients with a negative LA in whom the finding of moderate/high levels of aCL antibodies of the same isotype as those obtained in ab2GPI ELISA could reinforce the suspicion of APS. Thus, until new, more specific, assays, such as coagulation tests specific for pathogenic ab2GPI antibodies or an ELISA for the candidate pathogenic antibodies directed to domain I of b2GPI, are produced aCL antibodies should continue to be determined. Finally, while we do know positivity in all three tests shows a very significant association with clinical events in APS, we do not know what relation positive ab2GPI antibodies alone have to clinical events [4]. In any case, aCL values act as a control both for the quality of the antibodies tested and for the performance of ab2GPI ELISA in the laboratory. In fact, when ab2GPI are purified from high-risk patients with APS they produce positive results in both ab2GPI and aCL ELISAs [5]. As far as the IgM isotype is concerned, the majority of respondents (eight out of 13) deem that it is too early to eliminate it from the criteria. There is, nonetheless, little evidence in the literature demonstrating the association of IgM isotype with thromboembolism or pregnancy loss and many studies report that there is none. I am personally in favour of eliminating IgM isotype from APS criteria and to limiting its use to special cases such as those in which a positive LA is not associated with positive IgG isotype in aCL and ab2GPI ELISAs.