抗膜联蛋白A5抗体在抗磷脂综合征中的临床意义  

Clinical significance of anti-annexin A5 antibody in antiphospholipid syndrome

作　　者：陈思运 蒋慧 王楚涵 李君 黄璨 周央中 赵久良 李梦涛 曾小峰 赵岩 CHEN Si-yun;JIANG Hui;WANG Chu-han;LI Jun;HUANG Can;ZHOU Yang-zhong;ZHAO Jiu-liang;LI Meng-tao;ZENG Xiao-feng;ZHAO Yan(Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Peking Union Medical College Hospital,Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education,State Key Laboratory of Complex Severe and Rare Diseases,Ministry of Science&Technology,National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID),Beijing 100730,China)

机构地区：[1]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,风湿免疫病学教育部重点实验室,疑难重症及罕见病国家重点实验室,国家皮肤与免疫疾病临床医学研究中心,北京100730

出　　处：《中华临床免疫和变态反应杂志》2024年第1期16-20,共5页Chinese Journal of Allergy & Clinical Immunology

基　　金：科技部国家重点技术研究发展项目(2021YFC2501300);北京市科学技术委员会基金资助项目(Z201100005520026);中国医学科学院临床与转化医学研究基金资助项目(CIFMS2021-I2M-1-005);中央高水平医院临床科研业务费资助项目(2022-PUMCH-A008)。

摘　　要：目的探讨抗膜联蛋白A5(annexin A5,ANX A5)抗体与抗磷脂综合征(APS)患者临床特征的相关性及其检测的临床价值。方法2014年10月至2020年4月北京协和医院序贯纳入符合2006年悉尼修订APS分类标准的APS患者,收集患者人口统计学信息、临床特征及实验室检查结果,比较抗体阴性及阳性两组患者的组间差异。结果研究共纳入140例APS患者,其中抗ANX A5抗体阳性组57例(40.7%),阴性组83例(59.3%)。两组患者性别、年龄、病程、继发性APS比例无显著差异。临床特征中,抗ANX A5抗体阳性组(IgG/M阳性)较抗体阴性组合并脑梗死比例显著增多(33.3%vs.12.0%,P=0.003),其OR值为3.650,95%CI=1.544~8.628;抗ANX A5抗体双阳组(IgG及IgM均阳)脑梗死比例高达38.5%,OR值4.563,95%CI=1.246~16.711;其余部位血栓事件及病理妊娠无显著差异。实验室检查方面,两组间的抗心磷脂抗体(ACL)、抗β_(2)糖蛋白Ⅰ(β_(2)GPI)抗体、狼疮抗凝物(LA)等抗磷脂抗体阳性率比较,差异无统计学意义。结论APS患者中抗ANXA5抗体与脑梗死相关;合并该抗体阳性患者应警惕神经系统损害。Objective To investigate the correlation between anti-annexin A5(ANX A5)antibodies and clinical characteristics of patients with antiphospholipid syndrome(APS)and to evaluate the clinical value of its detection.Methods From October 2014 to April 2020,patients diagnosed with APS based on the 2006 Sydney revised APS classification criteria were consecutively enrolledat Peking Union Medical College Hospital.Demographic data,clinical characteristics,and laboratory findings were collected and compared between antibody-negative and antibody-positive groups.Results A total of 140 APS patients were included in the study.57 patients(40.7%)were in the anti-ANX A5 antibody-positive group,and 83 patients(59.3%)were in the negative group.There were no significant differences between the two groups in terms of gender,age,disease duration,or proportion of secondary APS.Among the clinical features,the incidence of cerebral infarction was significantly higher in the anti-ANX A5 antibody-positive group(IgG/M positive)compared to the antibody-negative group(33.3%vs.12.0%,P=0.003),with an OR of 3.650,95%CI=1.544-8.628.For patients with double positivity(both IgG and IgM classes positive),the proportion of cerebral infarction was as high as 38.5%,with an OR of 4.563,95%CI=1.246-16.711.There were no significant differences in thrombotic events in other sites and pathological pregnancies between the two groups.In terms of laboratory tests,there were no statistical differences in the positive rates of anticardiolipin antibody(ACL),anti-β_(2)glycoproteinⅠ(β_(2)GPI)antibodies,and lupus anticoagulant(LA)between the two groups.Conclusion Anti-ANX A5 antibodies are associated with cerebral infarction in APS patients.Patients with positive antibodies should be vigilant for potential neurological damage.

关 键 词：抗磷脂综合征 抗膜联蛋白A5抗体 脑梗死 

分 类 号：R446.6[医药卫生—诊断学] R593.2[医药卫生—临床医学]