抗磷脂抗体升高与住院患者院内血栓形成的相关性研究  

The relationship between elevated antiphospholipid antibodies and thrombosis in hospitalized patients

作　　者：史晓敏[1] 龚岩[1] 胡箫笛 翟乐 Shi Xiaomin;Gong Yan;Hu Xiaodi;Zhai Le(Department of Clinical Laboratory,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院检验科,北京100034

出　　处：《中华预防医学杂志》2021年第9期1100-1104,共5页Chinese Journal of Preventive Medicine

摘　　要：目的针对抗磷脂抗体升高的住院患者,评估抗磷脂抗体和院内血栓形成之间的相关性,比较不同种类的抗磷脂抗体对血栓形成的临床意义。方法病例对照研究。选取2015年1月至2019年12月期间在北京大学第一医院住院且抗磷脂抗体谱中任意一项检测结果为阳性的385例患者作为研究对象,男149例,女236例,年龄1~105岁、中位年龄37岁。依据住院期间是否经影像学检查检测到血栓将所有受试者分为血栓组和非血栓组。血栓组102例,男性66例,女性36例,年龄3~105岁、中位年龄58岁;非血栓组283例,男性83例,女性200例,年龄1~94岁、中位年龄31岁。记录患者的临床资料及实验室数据。抗心磷脂IgM/IgG抗体(aCL-IgM/IgG)和抗β2糖蛋白I IgM/IgG抗体(抗β2GPI-IgM/IgG)采用ELISA方法进行检测,狼疮抗凝物(LA)采用稀释的蝰蛇毒实验(dRVVT)和硅藻土凝固实验(SCT)方法在全自动凝血分析仪上进行检测。比较两组之间的年龄、性别、吸烟、肥胖、高血压、高血脂、糖尿病的发生率以及抗磷脂抗体中位数水平。通过Logistic多因素回归分析判断血栓事件发生的危险因素。用χ^(2)趋势检验确立aCL的中高滴度数值,并用Logistic回归验证。结果血栓组的中位年龄(58岁)以及男性(64.7%)、吸烟(16.7%)、高血压(63.7%)、糖尿病(28.4%)的比率明显高于非血栓组(Z=7.685,χ^(2)=38.077、16.312、37.769、24.749,P<0.01)。血栓组的抗β2GPI-IgG、dRVVT的阳性率(11.8%和78.4%)明显高于非血栓组(5.3%和60.1%),dRVVT的中位数水平(1.29 RU/ml)也高于非血栓组(1.23 RU/ml),差异有统计学意义(χ^(2)=3.864、10.309,Z=3.539,P<0.05)。aCL-IgM的中位数水平,非血栓组(2.3 MPL)高于血栓组(2.0 MPL)。aCL-IgG的阳性率,血栓组(18.6%)略高于非血栓组(10.6%)。Logistic多因素回归分析显示,男性、高血压、糖尿病、高龄、dRVVT升高、抗β2GPI-IgG升高是血栓的高危因素。以36 GPL作为aCL-IgG的中高滴度数�Objective Assess the relationship between elevated antiphospholipid antibodies and thrombosis in hospitalized patients.Methods Case control study.A total of 385 patients(149 males and 236 females,aged from 1 to 105 years,with a median age of 37 years)who were hospitalized in Peking University First Hospital from January 2015 to December 2019 and tested positive for any one of the anti-phospholipid antibodies were included in the study.All subjects were divided into thrombotic group and non-thrombotic group according to whether thrombus was detected by imaging examination during hospitalization.In thrombosis group,there were 66 males and 36 females,aged from 3 to 105 years,with a median age of 58 years.In non-thrombosis group,there were 83 males and 200 females,aged from 1 to 94 years,with a median age of 31 years.Clinical data and laboratory data of patients were recorded.ACL-IgM/IgG and anti-β2GPI-IgM/IgG were detected by ELISA and LA was detected by dRVVT and SCT on automatic coagulation analyzer.The rates of age,gender,smoking,obesity,hypertension,hyperlipidemia,diabetes and the median level of antiphospholipid antibodies were compared between two groups.Logistic multivariate regression analysis was used to determine the risk factors for thrombotic events.The mid-to-high titer value of aCL was established by theχ2-trend test and verified by logistic regression.Results The median age(58 years)and the rates of male(64.7%),smoking(16.7%),hypertension(63.7%)and diabetes(28.4%)in thrombus group were significantly higher than those in non-thrombus group(Z=7.685,χ²=38.077,16.312,37.769,24.749 respectively;P<0.01).The positive rate of anti-β2GPI-IgG and dRVVT in thrombosis group(11.8%and 78.4%)was significantly higher than that in non-thrombosis group(5.3%and 60.1%),as well as the median level of dRVVT(1.29 RU/ml vs 1.23 RU/ml)(χ²=3.864 and 10.309,Z=3.539;P<0.05).The median level of aCL-IgM was higher in non-thrombosis group(2.3 MPL vs 2.0 MPL).The positive rate of aCL-IgG was slightly higher in thrombosis grou

关 键 词：抗磷脂抗体 血栓形成 实验室 

分 类 号：R593.2[医药卫生—内科学]