血清阴性 "APS 综合征的抗体谱。

IF 3.4 3区 医学 Q3 IMMUNOLOGY Clinical and experimental immunology Pub Date : 2024-11-12 DOI:10.1093/cei/uxae079
Simona Truglia, Gloria Riitano, Silvia Mancuso, Serena Recalchi, Luca Rapino, Cristina Garufi, Valeria Manganelli, Tina Garofalo, Roberta Misasi, Cristiano Alessandri, Maurizio Sorice, Agostina Longo, Fabrizio Conti, Antonella Capozzi
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引用次数: 0

摘要

最近,抗磷脂综合征(APS)分类标准的更新包括了有别于血栓和产科发病的临床表现。然而,一些临床表现提示有 APS,但抗磷脂抗体(aPLs)[抗心磷脂抗体(aCL)、抗β2-糖蛋白 I 抗体(aβ2-GPI)和狼疮抗凝物]阴性的患者的存在可能提示诊断标准的更新。在本研究中,我们分析了血清阴性 APS(SN-APS)患者大型单中心队列中六种非标准 aPL 的流行率,以研究它们可能在诊断中的作用。化学发光法检测了 144 名 SN-APS 患者血清中的 aCL IgA、aβ2-GPI IgA 和 aβ2-GPI Domain 1 抗体,ELISA 法检测了抗磷脂酰丝氨酸/凝血酶原(aPS/PT)IgG、抗波形蛋白/心磷脂(aVim/CL)IgG 和抗氨甲酰化-β2-糖蛋白 I(aCarb-β2-GPI)IgG。在 SN-APS 患者中,4/144(2.77%)人检测到 aCL IgA,2/144(1.39%)人检测到 aβ2-GPI IgA,1/144(0.69%)人检测到 aβ2-GPI-Domain1,16/144(11.11%)人检测到 aPS/PT,37/144(25.69%)人检测到 aVim/CL,43/144(29.86%)人检测到 aCarb-β2-GPI。所有非标准 aPL 检测结果均为阴性的患者有 77/144 人(53.47%)。值得注意的是,维恩图显示,aCarb-β2-GPI 和 aVim/CL 是阳性抗体的主要组合。在 SN-APS 患者中,aCL IgA 与复发性血栓形成相关(OR11.48;p=0.03);在产科 SN-APS 患者中,aPS/PT 与胎儿死亡显著相关(OR4.84;p=0.01),aVim/CL 与自然流产相关(OR2.71;p=0.016)。这项研究表明,aPS/PT、aVim/CL 和 aCarb-β2-GPI 抗体可能是识别 "血清阴性 "APS 患者(标准 aPLs 阴性)的有用工具,这支持了让 SN-APS 患者更容易接受非标准 aPLs 检测的必要性。
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Antibody profiles in the mosaic of 'seronegative' APS syndrome.

Clinical manifestations, as distinct from thrombotic and obstetric morbidity, were recently included in the update of classification criteria of the antiphospholipid syndrome (APS). However, the existence of several patients with clinical manifestations suggestive of APS, but negative for criteria antiphospholipid antibodies (aPLs) [anti-cardiolipin antibodies (aCL), anti-β2-glycoprotein I antibodies (aβ2-GPI), and lupus anticoagulant] may suggest an update of diagnostic criteria. In this study, we analysed the prevalence of six non-criteria aPLs in a large monocentric cohort of patients with seronegative APS (SN-APS), to investigate their possible diagnostic role. aCL IgA, aβ2-GPI IgA, and aβ2-GPI Domain 1 antibodies were detected by chemiluminescence, anti-phosphatidylserine/prothrombin (aPS/PT) IgG, anti-vimentin/cardiolipin (aVim/CL) IgG, and anti-carbamylated-β2-glycoprotein I (aCarb-β2-GPI) IgG by ELISA in sera from 144 SN-APS patients. In SN-APS patients, aCL IgA was detected in 4/144 (2.77%), aβ2-GPI IgA in 2/144 (1.39%), aβ2-GPI-Domain 1 in 1/144 (0.69%), aPS/PT in 16/144 (11.11%), aVim/CL in 37/144 (25.69%), and aCarb-β2-GPI in 43/144 patients (29.86%). Patients negative for all non-criteria aPL assays were 77/144 (53.47%). Notably, the Venn diagram showed that aCarb-β2-GPI together with aVim/CL represented the prevalent combination of positive antibodies. In SN-APS patients, aCL IgA were associated with recurrent thrombosis (OR 11.48; P = 0.03); in obstetric SN-APS patients, aPS/PT were significantly associated with foetal deaths (OR 4.84; P = 0.01), aVim/CL with spontaneous abortions (OR 2.71; P = 0.016). This study indicates that aPS/PT, aVim/CL and aCarb-β2-GPI antibodies may represent useful tools to identify 'seronegative' APS patients, who are negative for criteria aPLs, supporting the need to make testing for non-criteria aPLs more accessible in patients with SN-APS.

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来源期刊
CiteScore
8.40
自引率
2.20%
发文量
101
审稿时长
3-8 weeks
期刊介绍: Clinical & Experimental Immunology (established in 1966) is an authoritative international journal publishing high-quality research studies in translational and clinical immunology that have the potential to transform our understanding of the immunopathology of human disease and/or change clinical practice. The journal is focused on translational and clinical immunology and is among the foremost journals in this field, attracting high-quality papers from across the world. Translation is viewed as a process of applying ideas, insights and discoveries generated through scientific studies to the treatment, prevention or diagnosis of human disease. Clinical immunology has evolved as a field to encompass the application of state-of-the-art technologies such as next-generation sequencing, metagenomics and high-dimensional phenotyping to understand mechanisms that govern the outcomes of clinical trials.
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