抗磷脂抗体与抗活化蛋白C抵抗关系的研究  

The relationship between anti-phospholipid antibodies and activated protein C resistance

作　　者：厉小梅[1] 李向培[1] 汪国生[1] 钱龙[1] 吴竞生 

机构地区：[1]安徽医科大学附属省立医院风湿免疫科,合肥230001 [2]安徽医科大学附属省立医院血液科,合肥230001

出　　处：《中华风湿病学杂志》2006年第4期206-208,共3页Chinese Journal of Rheumatology

基　　金：安徽省临床重点学科应用技术计划项目(05A018)

摘　　要：目的探讨抗磷脂抗体(APLs)与抗活化蛋白C(APCR)的关系。方法APCR检测以受检血浆加入活化蛋白C(APC)后的活化的部分凝血活酶时间(APTT)与未加APC血浆的APTT的敏感比值(APC-SR)表示,当APC-SR<2.0为APCR阳性。抗心磷脂抗体(ACL)检测和抗β2糖蛋白(β2GP)-Ⅰ抗体检测采用酶联免疫吸附试验。狼疮抗凝物(LA)采用激活的APTT测定法。结果LA与APCR有显著相关性(!2=16.332,P=0.008);而ACL-IgG、ACL-IgM和ACL-IgA3种ACL亚型均与APCR无统计学关系(!2=0.674,P=0.412;!2=2.978,P=0.071;!2=3.546,P=0.06);抗β2GP-Ⅰ抗体与APCR之间有显著相关性(!2=6.179,P=0.012)。APCR阳性组患者与阴性组患者的血栓形成及反复流产发生率差异有统计学意义(!2=7.347,P=0.007)。同时含有两种以上抗磷脂抗体17例(42.5%),APCR发生率达70.6%;血栓和/或反复流产64.7%,与含有一种APLs的病例比较差异有统计学意义(P=0.002)。结论LA和抗β2GP-Ⅰ抗体与APCR密切相关,APLs对蛋白C系统有抑制作用,APCR可能是诱发血栓的危险因素之一。APLs抗体的联合检测对并发血栓可能有预测价值。Objective To investigate the relationship between the anti-phospholipid antibodies （APLs） and activated protein C resistance （APCR）. Methods The response to activated protein C （APC） was studied by an APTT-based （clotting） assay with a Stago autoanalyzer and expressed as the ratio between the APTT obtained in the presence and absence of exogenous APC. APC sensitive ratio higher than 2 was regarded as APCR. Anti-β2-glycoprotein Ⅰ （132GP-Ⅰ ） antibody and anti-cardiolipin antibodies （ACL） were measured by an enzyme-linked immunosorbent assay （ELISA）. Lupus anticoagulant （LA） was tested by activated partial thromboplastin time （APTT）. Results The existence of LA and acquired APCR showed significant correlation （X^2=16.332, P=0.008）. Acquired APCR was significantly associated with the presence of anti-β2GP-Ⅰ antibody （X^2=6.179, P=0.012）, but not ACL. The presence of APCR was associated with an increased frequency of history of thromboembolic events and/or recurrent abortions （X^2=7.347, P=0.01 ）. Conclusion This study suggests that APCR is linked to the presence of LA and anti-β2GP-Ⅰ antibody. APLs may interfere with the activation of protein C. APCR phenotype may be a major risk factor for thrombophilia in patients with APLs. Combined detection of APLs has the potential value for predicting thrombosis.

关 键 词：活化蛋白C抵抗 易栓症 抗体 抗磷脂 

分 类 号：R593.2[医药卫生—内科学]