凝血相关因子抗体与抗磷脂综合征和血栓相关性研究  

Clinical significance and prevalence of some coagulation-related factors' antibodies in patients with antiphospholipid syndrome or systemic lupus erythematosus with thrombosis

作　　者：钱捷[1] 李树杰[1] 陈晓翔[1] 王元[1] 顾越英[1] 鲍春德[1] 陈顺乐[1] 杨程德[1] 

机构地区：[1]上海交通大学医学院附属仁济医院风湿病学科,200001

出　　处：《上海医学》2007年第3期161-164,共4页Shanghai Medical Journal

基　　金：国家自然科学基金(30371332);上海市科委基础研究重点项目(03JC14039);教育部归国基金;上海市曙光学者计划;上海市教委重点学科基金(T0203)

摘　　要：目的探讨某些凝血相关因子的自身抗体在抗磷脂综合征(APS)及系统性红斑狼疮(SLE)合并血栓患者中的临床意义。方法采用酶联免疫吸附试验(ELISA)分别检测APS组、SLE合并血栓亚组[抗心磷脂(aCL)抗体、抗β_2-糖蛋白Ⅰ(抗β_2-GPⅠ)抗体和狼疮抗凝物(LA)均阴性]、单纯SLE亚组(无血栓和病态妊娠史)和正常对照组(健康者)的aCL抗体、抗β_2-GPⅠ抗体、ZgG型抗纤溶酶抗体、IgG型抗凝血酶抗体、抗活化的蛋白C (APE)抗体和抗组织型纤溶酶原活化剂(t-PA)抗体。结果①APS组和SLE合并血栓亚组的IgG型抗纤溶酶抗体阳性率分别为29．2%和33．3%,均显著高于单纯SLE亚组的13．3%(P值分别＜0．01、0．05),前两组间的差异无统计学意义(P＞0．05)。②APS组和SLE合并血栓亚组的IgG型抗凝血酶抗体阳性率分别为38．5%和50．0%,均显著高于单纯SLE亚组的14．2%(P值均＜0．01),前两组间的差异无统计学意义(P＞0．05)。③3组间IgG型抗APC抗体、抗t-PA抗体的差异均无统计学意义(P值均＞0．05)。④IgG型抗纤溶酶、抗凝血酶抗体与血栓/病态妊娠史有关联(P=0．002、0．001)。结论IgG型抗纤溶酶抗体和抗凝血酶抗体与血栓表现相关,临床上对于持续的aCL抗体、抗β_2-GPI抗体和LA均阴性的SLE伴有血栓患者,检测IgG型抗纤溶酶抗体、抗凝血酶抗体可能有助于一些APS病例的诊断。Objective To appraise the role of some related coagulation factors＇ antibodies in patients with antiphospholipid syndrome（APS） and systemic lupus erythematosus（SLE） with thrombosis. Methods Three groups of patients were studied： antiphospholipid syndrome（APS） patients; SLE patients with a history of thrombosis （SLE/thrombosis） and persistently negative for anti-cardiolipin （aCL） antibodies, anti-β2-glycoprotein I （β2-GPI） antibodies and lupus anticoagulant（LA） ; SIrE patients without thrombotic history and pregnancy morbidity events （SIRE only）. All patients were tested for aCL, anti-β2-GPI, plasmin, thrombin, activated protein C（APC）, tissuetype plasminogen activator（t-PA） antibodies by coating plates with respective antigens. Results （1）The positive rates of IgG anti-plasmin antibody in APS patients（29.2 %） and SLE/thrombosis patients （33.3 %） were higher than SLE only patients（13.3%, P 〈 0.01, P 〈 0.05 respectively）. No differences of IgG anti-plasmin antibody levels were found between the APS and the SLE/thrombosis group（P 〉 0.05）. （2）The positive rates of IgG antithrombin antibody in APS patients（38.5 % ） and SLE/thrombosis patients（50.0 % ） were higher than SLE patients （14.2 %, P 〈 0.01 for both）. No differences of IgG anti-thrombin antibody levels were found between the APS and the SLE/thrombosis group（P 〉 0.05）. （3）The prevalence of IgG anti-APC and t-PA antibodies did not differ between the APS group and the SLE/thrombosis or the SLE groups（P 〉 0.05 for all）. （4）The presence of IgG anti-plasmin and thrombin antibodies were associated with thrombosis and pregnancy morbidity. Conclusion IgG anti-plasmin or thrombin antibody is related to thrombosis. Testing for IgG anti-plasmin or thrombin antibody in SLE patients with thrombosis, but repeatedly negative for aCL, anti-β2-GPI antibodies and I.A may be helpful in identifying this disease. （Shanghai Med J, 2007, 30..161-164）

关 键 词：抗磷脂综合征 血栓形成 抗磷脂抗体 狼疮抗凝物 

分 类 号：R593.2[医药卫生—内科学]