Measuring IgA Anti-β2-Glycoprotein I and IgG/IgA Anti-Domain I Antibodies Adds Value to Current Serological Assays for the Antiphospholipid Syndrome.
Measuring IgA Anti-β2-Glycoprotein I and IgG/IgA Anti-Domain I Antibodies Adds Value to Current Serological Assays for the Antiphospholipid Syndrome.
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DOI：
10.1371/journal.pone.0156407
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Rahman A
中科院分区：
文献类型：
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作者：
Pericleous C;Ferreira I;Borghi O;Pregnolato F;McDonnell T;Garza-Garcia A;Driscoll P;Pierangeli S;Isenberg D;Ioannou Y;Giles I;Meroni PL;Rahman A
目前可用的临床检测方法可检测抗磷脂抗体 (aPL)，检测针对心磷脂 (aCL) 和 β2-糖蛋白 I (aβ2GPI) 的 IgG 和 IgM 抗体。有人建议，测试 IgA aPL 和 I 域 (DI) 抗体（携带 β2GPI 的关键抗原表位）可以为当前的测试增加价值。我们进行了一项观察性多中心队列研究，以评估 IgG、IgM 和 IgA 检测对 APS 中 CL、β2GPI 和 DI 的效用。对 230 名 APS 患者 (n = 111)、SLE 但非 APS 患者 (n = 119) 以及 200 名健康对照者的血清进行了 IgG、IgM 和 IgA aCL、aβ2GPI 和 aDI 活性检测。 APS 患者进一步分为血栓性 APS 或产科 APS。采用逻辑回归和受试者操作特征分析来比较九种不同测定的结果。所有检测均对 APS 表现出良好的特异性；然而，IgG aCL 和 IgG aβ2GPI 检测具有最高的灵敏度。与 IgM aβ2GPI 相比，IgA aβ2GPI 检测呈阳性导致 APS 的风险比更高。 IgG、IgM 或 IgA aDI 阳性均与 APS 相关，并且在 aCL 和/或 aβ2GPI 阳性受试者中，aDI 的存在使 APS 的风险比提高了 3-5 倍。 IgG aCL、aβ2GPI、aDI 和 IgA aDI 与 APS 患者的血栓形成相关，但与产科并发症无关。测量 IgG aDI 和 IgA aβ2GPI 和 aDI 可能有助于治疗 APS，特别是血栓性 APS 患者。
Currently available clinical assays to detect antiphospholipid antibodies (aPL) test for IgG and IgM antibodies to cardiolipin (aCL) and β2-glycoprotein I (aβ2GPI). It has been suggested that testing for IgA aPL and for antibodies to Domain I (DI), which carries the key antigenic epitopes of β2GPI, could add value to these current tests. We performed an observational, multicenter cohort study to evaluate the utility of IgG, IgM and IgA assays to each of CL, β2GPI and DI in APS. Serum from 230 patients with APS (n = 111), SLE but not APS (n = 119), and 200 healthy controls were tested for IgG, IgM and IgA aCL, aβ2GPI and aDI activity. Patients with APS were further classified into thrombotic or obstetric APS. Logistic regression and receiver operator characteristic analyses were employed to compare results from the nine different assays. All assays displayed good specificity for APS; IgG aCL and IgG aβ2GPI assays however, had the highest sensitivity. Testing positive for IgA aβ2GPI resulted in a higher hazard ratio for APS compared to IgM aβ2GPI. Positive IgG, IgM or IgA aDI were all associated with APS, and in subjects positive for aCL and/or aβ2GPI, the presence of aDI raised the hazard ratio for APS by 3–5 fold. IgG aCL, aβ2GPI, aDI and IgA aDI were associated with thrombotic but not obstetric complications in patients with APS. Measuring IgG aDI and IgA aβ2GPI and aDI may be useful in the management of patients with APS, particularly thrombotic APS.