摘要/Abstract

摘要： 目的 ·研究抗磷脂酰丝氨酸 /凝血酶原复合物抗体（ anti-phosphatidylserine/ prothrombin antibody，aPS/PT）、IgA型抗心磷脂抗体（ anti-cardiolipin antibody，aCL）及 IgA型抗 β2糖蛋白 1抗体（ anti-β2-glycoprotein Ⅰ antibody，aβ2-GPI）对血清阴性抗磷脂综合征（seronegative antiphospholipid，SNAPS）的诊断价值。方法 ·选取 86例抗磷脂综合征（antiphospholipid，APS）患者（APS组）、 48例 SNAPS患者（ SNAPS组）、 79例系统性红斑狼疮（ systemic lupus erythematosus，SLE）患者（ SLE组）和 85例健康者（健康对照组），应用 ELISA法测定 IgG型和 IgM型 aPS/PT、IgA型 aCL和 IgA型 aβ2-GPI 4种抗磷脂抗体。计算这 4种抗体用于诊断 SNAPS的敏感度及特异度，并做受试者工作特征（ ROC）曲线，以及分析 4种抗体与 SNAPS临床表现的相关性。结果 · SNAPS组 aPS/PT总检出率为 52.1%，其中 IgG型 aPS/PT检出率为 29.2%，IgM型 aPS/PT检出率为 35.4%，IgA型 aβ2-GPI检出率为 16.7%， IgA型 aCL未检出；SNAPS组 IgG型和 IgM型 aPS/PT，以及 IgA型 aβ2-GPI检出率显著高于健康对照组（均 P0.000）。IgG型 aPS/PT用于诊断 SNAPS的 ROC曲线下面积最大，其次为 IgA型 aβ2-GPI，分别为 0.753和 0.725。IgG型 aPS/PT（OR5.54，95% CI 1.67～ 17.33，P0.003）和 IgA型 aβ2-GPI（OR3.43，95% CI 0.86～ 11.53，P0.041）与静脉血栓风险均呈正相关， IgM型 aPS/PT与妊娠丢失风险正相关（ OR5.11，95% CI 1.31～ 21.29，P0.004）。结论 · IgG/IgM型 aPS/PT和 IgA型 aβ2-GPI可作为 SNAPS实验室诊断潜在的补充指标，IgG/IgM型 aPS/PT对于临床评估 SNAPS患者血栓形成和妊娠丢失的风险也有一定的应用价值。
关键词: 抗磷脂综合征, 抗磷脂酰丝氨酸 /凝血酶原复合物抗体, 血清学阴性抗磷脂综合征, 诊断
Abstract:
Objective · To investigate diagnostic value of anti-phosphatidylserine/prothrombin antibody (aPS/PT), IgA anti-cardiolipin antibody (aCL), and IgA anti-β2-glycoprotein Ⅰ antibody (aβ2-GPI) in seronegative antiphospholipid (SNAPS). Methods · Serum samples were collected 86 patients with antiphospholipid (APS) (APS group), 48 patients with SNAPS (SNAPS group), 79 patients with systemic lupus erythematosus (SLE) (SLE group), and 85 healthy donors (healthy control group, HC group) for aPS/PT (IgG and IgM), aCL (IgA) and aβ2-GPI (IgA) detectedELISA. The sensitivity and specificity of the four antibodies for the diagnosis of SNAPS were calculated, and the ROC curves were analyzed. The correlation between the four antibodies and the clinical manifestations of SNAPS was also analyzed. Results · A total of 25 (52.1%) SNAPS patients were positive in aPS/PT (IgG/ IgM), including 29.2% patients positive in aPS/PT (IgG) and 35.4% positive in aPS/PT (IgM). There were 16.7% SNAPS patients positive in aβ2-GPI (IgA), but none was aCL (IgA) positive. The positive rates of aPS/PT (IgG and IgM) and aβ2-GPI (IgA) were statistically higher in SNAPS group than those in HC group (P0.000). The area under curve (AUC) of aPS/PT (IgG) (AUC0.753) for SNAPS diagnosis was the biggest among the four antibodies, and the second was aβ2-GPI (IgA) (AUC0.725). A positive correlation was found in SNAPS group between presence of venous thrombosis and aPS/PT (IgG) (OR5.54, 95% CI 1.67-17.33, P0.003) or aβ2-GPI (IgA) (OR3.43, 95% CI 0.86-11.53, P0.041), and also found between pregnancy loss and aPS/PT (IgM) (OR5.11, 95% CI 1.31-21.29, P0.004). Conclusion · aPS/PT (IgG/IgM) and aβ2-GPI (IgA) can be used as potential complementary indicators for laboratory diagnosis of SNAPS, and aPS/PT (IgG/IgM) is also valuable for clinical evaluation of the risk of thrombosis and pregnancy loss in SNAPS patients.
Key words: antiphospholipid syndrome (APS), anti-phosphatidylserine/prothrombin antibody (aPS/PT), seronegative antiphospholipid syndrome (SNAPS), diagnosis


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