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抗磷脂血栓综合征与获得性抗活化的蛋白C现象

Antiphospholipid thrombosis syndrome and acquired activated protein C resistance

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【作者】 吴竞生周志中李向培厉晓梅陈育华汪国生徐修才王祖贻

【Author】 WU Jingsheng; ZHOU Zhizhong; LI Xiangpei; et al. (Anhui Provincial Hospital, Hefei 230001, China)

【机构】 安徽省立医院!合肥230001

【摘要】 目的了解抗磷脂抗体(APA),抗活化的蛋白C(APCR)与抗磷脂血栓综合征(APL-T)的关系,进一步探讨APL-T血栓发生机制。方法以ELISA检测ACA(IgG,IgM,IgA);APTT检测LA;APTT+/-APC检测APCR。结果20例患者符合APL-T诊断。根据病因分类,100例SLE患者中14例为继发性APL-T;16例“原因不明”血栓与习惯性流产患者中6例为原发性APL-T。根据抗体分类,20例患者中12例LA阳性为狼疮抗凝因子血栓综合征(LA-T);20例患者中12例ACA阳性为抗心磷脂抗体血栓综合征(ACA-T)。根据临床症状分类,20例患者中7例静脉血栓为Ⅰ型APL-T;3例脑梗死为Ⅱ型APL-T;1例静脉血栓合并脑梗死,习惯性流产为Ⅳ型(混合型)APL-T;9例习惯性流产为V型APL-T。ACA,LA与APL-T相关;APCR与APL-T密切相关。结论APA、LA引起获得性APCR可能是APL-T血栓的重要原因。

【Abstract】 Objective To explore the cormlation between antiphospholipid antibodies (APA) activated pro-tein C resistance (APCR) and antiphospholipid thrombosis (APL-T) syndrome and investigate the mechanism ofthrombosis in APL-T syndrome. Methods ELISA, APTT-LA and APTT + / - APC methods were used to detectanticardiolipin antibodies (ACA), lupus anticoagulants(LA) and APCR in 20 APL-T syndrome patients respective-ly. Results Twenty patients were diagnosed as APL-T. The patients were classified in three ways. According toetiology, 14 of 100 systemic lupus erythematosus (SLE) patients were diagnosed as "secondary" APL-T, and 6 of16 "unexplained" thrombosis and spontaneous abortion as "Primary" APL-T syndrome. According to antibodies, 12of 20 patients with positive LA were diagnosed as lupus anticoagulant thrombosis syndrome (LA-T),12 of 20 pa-tients with positive ACA as anticardiolipin antibodies thrombosis syndrome (ACA-T). According to clinical presenta-tion: 7 of 20 patients with deep vein thrombosis were classified as type Ⅰ APL-T, 3 of 20 patients with cerebrovas-cular thrombosis as type Ⅱ, l of 20 patients with vein cerebrovascular thrombosis and spontaneous abortion as typeⅣ (mixing), and 9 of 20 patients with spontaneous abortion as type Ⅴ (fetal wastage type). The ACAs and LA arestrongly associated with APL-T. There is close relationship between APCR and APLT. Conclusion The acquiredAPCR might be an important reason for thrombosis in APL-T caused by APA and LA.

【基金】 安徽省自然科学基金!98452234
  • 【文献出处】 中华血液学杂志 ,CHINESE JOURNAL OF HEMATOLOGY , 编辑部邮箱 ,2000年03期
  • 【分类号】R442.8
  • 【被引频次】9
  • 【下载频次】72
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