中文摘要：

目的 探讨不同亚型（IgG、IgM和IgA型）抗心磷脂抗体（aCL）和抗β2糖蛋白1抗体（抗β2GP1抗体）,以及狼疮抗凝物（LA）在系统性红斑狼疮（SLE）诊断中的价值.方法 病例对照研究.2012年1月至2013年9月在北京协和医院风湿免疫科确诊为SLE的患者共100例（其中42例确诊为继发性抗磷脂综合征,SAPS）,44名健康对照者和32例除外SLE和抗磷脂抗体综合征（APS）的其他结缔组织病患者采用酶联免疫吸附法（ELISA）分别用IgA/G/M多亚型筛选试剂和IgA、IgG、IgM单亚型试剂检测aCL和抗β2GP1抗体,采用改良的稀释蝰蛇毒磷脂时间（dRVVT）检测狼疮抗凝物（LA）,并回顾分析SLE患者中抗磷脂抗体与APS临床表现的相关性.采用x2检验比较SLE组、健康对照组及其他结缔组织疾病组中抗磷脂抗体的阳性率,不同组间抗体浓度分布的比较采用独立样本Kruskal-Wallis检验.抗磷脂抗体与APS临床表现的相关性采用Spearman相关分析.在SLE组患者中,以APS的临床诊断作为金标准,采用四格表统计抗磷脂抗体对APS的诊断效能.结果 SLE组中IgG型aCL（x2=15.031,P＜0.001）,IgA/G/M型（x2=11.678,P =0.003）和IgA型（x2 =6.17,P =0.036）抗β2GP1抗体的阳性率高于健康对照组和疾病对照组,差异有统计学意义.IgA/G/M型（r=0.207,P=0.039）,IgG（r=0.230,P=0.021）和IgA型（r=0.217,P=0.030） aCL,IgA/G/M型（r=0.218,P=0.029）和IgA型（r=0.255,P=0.叭）抗β2GP1抗体,及LA（r =0.233,P =0.02）与血栓事件相关.IgA/G/M型抗β2GP1抗体（r=0.22,P=0.029）和LA（r=0.254,P=0.011）与病态妊娠相关.aCL阳性的SLE患者中,23.1％ （6/26）仅IgM和/或IgA亚型阳性;抗β2GP1抗体阳性的SLE患者中,53.6％（15/28）仅IgM和/或IgA亚型阳性.在SLE患者中,IgA/G/M型aCL对APS的特异度和敏感度分别为98.3％和26.2％,IgA/G/M型抗β2GP1抗体对APS的特异度和敏感度分别为84.5％和40.5％.当2种以上抗体亚型阳性时,aCL和抗p2GP1抗体对APS

英文摘要：

Objective To investigate the prevalence and clinical significance of different subtypes （IgG,IgM and IgA） of anticardiolipin antibodies （aCL） and anti-β2-glycoprotein Ⅰ antibodies （aβ 2GP1）,as well as lupus anticoagulant （LA） in systemic lupus erythematosus （SLE）.Methods IgG/IgM/IgA,IgG,IgM,IgA aCL and anti-β2GP1 were tested by enzyme-linked immunosorbent assay （ELISA） in 100 patients with SLE （42 patients were diagnosed as secondary antiphospholipid syndrome）,44 healthy controls and 32 patients with other connective tissue diseases excluding SLE and antiphospholipid syndrome （APS）.Meanwhile,LA was tested by modified Dilute Russell＇s viper venom time （dRVVT）.The correlation between antiphospholipid antibodies and clinical manifestation was analyzed by Spearman correlation analysis.The postiverate of antiphospholipid antibodies in SLE patients,health controls and patients with other connective tissue diseases were compared by chi square test.The concentrations of antiphospholipid antibodies in different groups were compared using independent sample Kruskal Wallis test.The diagnostic efficacy of antiphospholipid antibodies in SLE patients was analyzed by crosstable using clinical diagnosis of APS as gold standard.P ＜ 0.05 was considered statistically significant.Results The prevalence of IgG aCL （x2 =15.031,P ＜ 0.001）,IgA/G/M （x2 =11.678,P =0.003） and IgA （x2 =6.17,P =0.036） antiβ2GP1 were significantly higher in patients with SLE than in the other two groups.IgA/G/M （r =0.207,P=0.039）,IgG （r=0.230,P=0.021） and IgA （r=0.217,P=0.030） aCL,IgA/G/M （r=0.218,P=0.029） and IgA （r =0.255,P =0.01） anti-β2GP1,as well as LA （r =0.233,P =0.02） were associated with thrombotic events.IgA/G/M anti-β2GP1 （r =0.22,P =0.029） and LA （r =0.254,P =0.011） were associated with pathological pregnancy.23.1％ （6/26） aCL positive SLE patients were IgM and/or IgA aCL positive.53.6％ （15/28） anti-β2GP1 positive SLE patients were IgM and/or