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-glycoproteinⅠantibody,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a PS/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P=0.000)。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(OR=5.54,95%CI1.67～17.33,P=0.003)和IgA型aβ2-GPI(OR=3.43,95%CI 0.86～11.53,P=0.041)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(OR=5.11,95%CI 1.31～21.29,P=0.004)。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。
Objective · To investigate diagnostic value of anti-phosphatidylserine/prothrombin antibody(aPS/PT), IgA anti-cardiolipin antibody(aCL),and IgA anti-p2-glycoprotein I antibody(ap2-GPI) in seronegative antiphospholipid(SNAPS). Methods · Serum samples were collected from 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 αβ2-GPI(IgA) detected by ELISA. 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 αβ2-GPI(IgA),but none was aCL(IgA) positive. The positive rates of aPS/PT(IgG and IgM) and αβ2-GPI(IgA) were statistically higher in SNAPS group than those in HC group(P=0.000). The area under curve(AUC) of aPS/PT(IgG)(AUC=0.753) for SNAPS diagnosis was the biggest among the four antibodies, and the second was ap2-GPI(IgA)(AUC=0.725). A positive correlation was found in SNAPS group between presence of venous thrombosis and aPS/PT(IgG)(OR=5.54, 95% CI 1.67-17.33, P=0.003) or ap2-GPI(IgA)(OR=3.43, 95% CI0.86-11.53, P=0.041),and also found between pregnancy loss and aPS/PT(IgM)(OR=5.11.95% CI 1.31-21.29,P=0.004).Conclusion.aPS/PT(IgG/IgM)and ap2-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.
引文
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