IgA类抗磷脂抗体对抗磷脂综合征的诊断价值  

Value of IgA antiphospholipid antibodies in diagnosis of the antiphospholipid syndrome

作　　者：杨滨[1] 赵久良 黄卓春[1] 苏真珍[1] 李梦涛 曾小峰 胡朝军 Yang Bin;Zhao Jiuliang;Huang Zhuochun;Su Zhenzhen;Li Mengtao;Zeng Xiaofeng;Hu Chaojun(Department of Laboratory Medicine,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID)Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education,Beijing 100730,China)

机构地区：[1]四川大学华西医院实验医学科,成都610041 [2]中国医学科学院,北京协和医学院,北京协和医院风湿免疫科,国家皮肤与免疫疾病临床医学研究中心,风湿免疫病学教育部重点实验室,北京100730

出　　处：《中华医学杂志》2021年第41期3404-3410,共7页National Medical Journal of China

基　　金：国家重点研发计划(2019YFC0840603);国家自然科学基金(81771780);中国医学科学院医学与健康科技创新工程(2017-I2M-3-001)。

摘　　要：目的分析多种抗磷脂抗体(aPL)亚型在健康人群与抗磷脂综合征(APS)患者中的分布情况,并探讨IgA-aPL检测在APS诊断中的临床应用价值。方法依据2006年悉尼国际APS分类标准,选取2019年7至12月就诊于北京协和医院和四川大学华西医院的APS患者共计218例纳入研究。其中男66例,女152例,年龄(44.5±15.4)岁,包括原发性APS患者148例,继发性70例,并同期1∶1收集年龄、性别匹配的健康对照。以化学发光免疫分析法检测研究对象血清样本中IgA/IgG/IgM型抗心磷脂抗体(aCL)及抗β_(2)糖蛋白Ⅰ抗体(aβ_(2)GPI)。比较分析组间各指标的差异,并应用受试者工作特征(ROC)曲线分析IgA-aPL对APS的诊断价值。结果APS患者中,IgA-aCL、IgA-aβ_(2)GPI的阳性率分别为20.6%、15.6%,而在IgG/IgM-aCL或IgG/IgM-aβ_(2)GPI阴性的个体中,二者的孤立阳性率仅分别为2.3%、0.9%。IgA-aCL、IgA-aβ_(2)GPI孤立阳性不能用于有效识别APS患者(P=0.216、1)。联合IgG/IgM-aCL诊断APS的ROC曲线下面积(AUC)为0.833,明显优于IgG-aCL单独使用时(AUC=0.776,P<0.01),而IgA/IgG/IgM-aCL三联检测时AUC为0.833,并不能进一步提升对APS的诊断价值(P=0.287)。对aβ_(2)GPI而言,联合IgG/IgM(AUC=0.875)或IgA/IgG/IgM型抗体(AUC=0.875)的诊断效能与IgG-aβ_(2)GPI单独使用(AUC=0.869)时相较,差异均无统计学意义(均P>0.05)。此外,IgA-aPL阳性APS患者更易发生心脏瓣膜损伤(P=0.044)及血小板减少症(P=0.014)。结论在已有的狼疮抗凝物、IgG/IgM型aCL和aβ_(2)GPI等血清学标志物基础上,增加IgA-aCL与IgA-aβ_(2)GPI并不能进一步提升实验室检查对APS的预测价值,但IgA-aPL与心脏瓣膜损伤及血小板减少症等临床症状相关。Objective To examine the prevalence of multiple antiphospholipid antibodies(aPL)subtypes in healthy people and antiphospholipid syndrome(APS)patients,and to assess the value of IgA-aPL in the diagnosis of APS.Methods According to the 2006 Sydney International APS Classification Criteria,a total of 218 APS patients who were admitted to Peking Union Medical College Hospital or West China Hospital of Sichuan University from July to December 2019 were enrolled.Among them,66 were males,and 152 were females,aged(44.5±15.4)years,including 148 primary APS patients and 70 secondary APS patients.Age-and gender-matched controls were collected at the same period at the ratio of 1∶1 with the APS cases.IgA/IgG/IgM anticardiolipin antibodies(aCL)and anti-β_(2) glycoprotein I antibodies(aβ_(2)GPI)were detected by chemiluminescent immunoassay.The differences of indicators between groups were analyzed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of IgA-aPL for APS.Results The positivity of IgA-aCL and IgA-aβ_(2)GPI was 20.6%and 15.6%in the APS patients,while in the IgG/IgM-aCL or IgG/IgM-aβ_(2)GPI negative individuals,the isolated positivity of IgA-aCL and IgA-aβ_(2)GPI was only 2.3%and 0.9%,respectively.Accordingly,IgA-aCL and IgA-aβ_(2)GPI isolated positivity could be used to diagnose APS(P=0.216,1,respectively).The area under the ROC curve(AUC)of IgG/IgM-aCL for APS diagnosis was 0.833,which was significantly better than that of IgG-aCL alone(AUC=0.776,P<0.001);while the AUC of IgA/IgG/IgM-aCL was 0.833,which could not further increase the diagnostic value for APS(P=0.287).As for aβ_(2)GPI,the diagnostic efficacy of combined IgG/IgM(AUC=0.875)or IgA/IgG/IgM(AUC=0.875)antibodies was not superior to IgG-aβ_(2)GPI used alone(AUC=0.869,both P>0.05).Besides,patients with IgA-aPL were more likely to have heart valve lesions and thrombocytopenia(both P<0.05).Conclusion Based on the existing serological markers,such as lupus anticoagulant,IgG/IgM subtype of aCL and aβ_(2)GPI,

关 键 词：抗磷脂综合征 抗心磷脂抗体 抗β_(2)糖蛋白Ⅰ抗体 诊断 

分 类 号：R593.2[医药卫生—内科学]