Correlations of anti-cardiolipin antibody and anti-β2 glycoprotein I antibody with ischemic stroke in patients with systemic autoimmune diseases / 中国基层医药

Objective:To correlate anti-cardiolipin antibody (aCL) and anti-β2 glycoprotein I antibody (aβ2GPI) with ischemic stroke (IS) in patients with systemic autoimmune diseases (SADs).Methods:A total of 104 patients with SADs who received treatment in the Affiliated Hospital of North Sichuan Medical College during January to December 2019 were included in this study. They were divided into two groups whether they had IS (IS group, n = 42) or not (non-IS group, n = 62). aPL positive rate was qualitatively compared between the IS and non-IS groups. aCL and aβ2GPI expression levels were quantitatively compared between the IS and non-IS groups. Logistic regression analysis was performed to evaluate the risk factors for IS in patients with SADs. Results:aPL positive rate in the IS group was significantly higher than that in the non-IS group [61.9% (26/42) vs. 40.3% (25 /62), χ2 = 4.66, P = 0.031]. The aCL-IgM and aβ2GPI-IgM levels in the IS group were (22.82 ± 27.27) RU/mL and (18.70 ± 23.95) RU/mL, respectively, which were significantly higher than those in the non-IS group [(13.34 ± 8.43) RU/mL, (7.61± 5.80) RU/mL, t = -2.18, -2.76, P = 0.034, 0.009]. Logistic regression analysis showed that aPL is an independent risk factor for IS ( P = 0.037). Conclusion:aCL and aβ2GPI are closely related to the occurrence of IS and are the independent risk factors for IS in patients with SADs.

Detection of antiphospholipid antibody levels in normal pregnant women by chemiluminescence immunoassay and comparison between different trimesters / 中华围产医学杂志

Objective:Chemiluminescence immunoassay was used to detect the levels of anticardiolipin antibody (aCL) -IgA/IgG/IgM and anti-β2-glycoprotein Ⅰ antibody (aβ2GPⅠ) -IgA/IgG/IgM in healthy non-pregnant and pregnant women to explore the changes of antiphospholipid antibody in different pregnancy periods.Methods:This prospective study was conducted in Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, involving normal pregnant women who underwent prenatal examination and healthy non-pregnant women with no history of adverse pregnancy who underwent progestational eugenic health examination from April 2020 to August 2021. The levels of aCL-IgA/IgG/IgM and aβ2GPⅠ-IgA/IgG/IgM were detected using BIO-FLASH chemiluminescence immunoassay analyzer and P95 as well as P99 were calculated, respectively. The difference in the six data between non-pregnant and pregnant women was compared using Mann-Whitney U test. Kruskal-Wallis H test was used to compare the change of each antibody in different pregnancy periods and Spearman correlation was used to analyze the correlation between different trimester and the levels of aCL-IgA/IgG/IgM and aβ2GPⅠ-IgA/IgG/IgM. Results:A total of 454 cases met the inclusion criteria, and 435 cases were included in the analysis after excluding 19 cases, among them 110 were non-pregnant women and 325 were pregnant women, including 110 cases in the first trimester (≤13 +6 weeks), 110 cases in the second trimester(14 +0-27 +6 weeks), and 105 cases in the third trimester (≥28 weeks). P99 value of aCL-IgA/IgG/IgM and aβ2GPⅠ-IgA/IgG/IgM in the non-pregnant women were 7.31, 14.70, 7.92, 3.58, 13.60, and 4.95 CU, which in the pregnant women were 5.90, 12.78, 5.70, 1.60, 10.65, and 3.90 CU, and were all lower than the cut-off value of 20 CU that given by the analyzer manufacturer. The levels of aCL-IgA/IgG/IgM, and aβ2GPⅠ-IgG/IgM in the pregnant women were significantly decreased comparing with the non-pregnant women [aCL-IgA: 1.90 CU (1.40-2.70 CU) vs 2.90 CU (2.20-3.83 CU), Z=－7.14; aCL-IgG: 3.00 CU (2.20-4.50 CU) vs 6.10 CU (4.20-7.83 CU), Z=－10.26; aCL-IgM: 1.40 CU (1.10-2.30 CU) vs 2.65 CU (2.08-3.73 CU), Z=－8.87; aβ2GPⅠ-IgG: 3.50 CU (2.60-4.90 CU) vs 4.75 CU (3.60-5.93 CU), Z=－5.45; aβ2GPⅠ-IgM: 0.70 CU (0.50-1.20 CU) vs 1.00 CU (0.60-1.53 CU) , Z=－3.73; all P<0.001]. The aCL-IgA level in the third trimester was higher than those in the first and second trimester (both P<0.05). The levels of aCL-IgG/IgM in the second trimester and aβ2GPⅠ- IgG in the second and third trimesters were significantly decreased than those in the first trimester (all P<0.05). Spearman analysis showed that aCL-IgG/IgM, aβ2GPⅠ-IgA/IgM had no significant correlation with the pregnancy period (the first, second and the third trimester) (all P>0.05). However, a weak correlation between the aCL-IgA, aβ2GPⅠ- IgG and the pregnancy period was observed ( r=0.28 and－0.49, both P<0.001) Conclusions:P99 value of aCL-IgA/IgG/IgM and aβ2GPⅠ-IgA/IgG/IgM levels in normal pregnant women and non-pregnant women are lower than the cut-off value of 20 CU given by the analyzer manufacturer. The levels of aCL-IgA/IgG/IgM and aβ2GPⅠ-IgG/IgM during pregnancy are lower than those before pregnancy and fluctuate with the pregnancy period, but have no significant correlation with the pregnancy period. The clinical diagnosis of antiphospholipid syndrome should be made according to the cut-off values of aCL-IgA/IgG/IgM and aβ2GPⅠ-IgA/IgG/IgM determined by each laboratory.

Systemic lupus erythematosus with extensive intracranial calcification: a case report / 中华神经科杂志

Extensive intracranial calcification is rare in patients with systemic lupus erythematosus. This article reported a patient with antiphospholipid antibody syndrome secondary to systemic lupus erythematosus, complicated with bilateral symmetrical extensive intracranial calcification. By reviewing literature, the results suggested that the flare of neuropsychiatric systemic lupus erythematosus and the presence of antiphospholipid antibodies may be risk factors for intracranial calcification. Therefore, in order to prevent the formation of intracranial calcification, it is necessary to maintain continuous disease remission and anticoagulant therapy.

Non-criteria Antiphospholipid Antibodies: a narrative review

SUMMARY The 2006 Revised Sapporo Classification Criteria for Definite Antiphospholipid Syndrome included as laboratory criteria the tests for antiphospholipid antibodies whose accuracy was regarded as satisfactory according to the evidence available at that time. In practice, however, the sensitivity and specificity of these "criteria" of antiphospholipid antibodies are sometimes insufficient for identifying or ruling out antiphospholipid syndrome. It has been studied whether the accuracy of the laboratory diagnosis of the syndrome could be improved by testing for non-criteria antiphospholipid antibodies. In this work, we review evidence on the clinical associations and diagnostic value of the most commonly studied non-criteria antibodies, namely: antiphosphatidylethanolamine, anti-annexin A5, anti-prothrombin, anti-phosphatidylserine/prothrombin complex, IgA anticardiolipin, and IgG anti-domain I of the β2 glycoprotein antibodies.

RESUMO A classificação de Sapporo revisada para a síndrome antifosfolipídica definida de 2006 incluiu como critérios laboratoriais aqueles testes para anticorpos antifosfolípides cuja acurácia era considerada satisfatória de acordo com a evidência então disponível. Porém, na prática, a sensibilidade e especificidade desses anticorpos antifosfolípides "critério" são por vezes insuficientes para identificar ou descartar a síndrome antifosfolípide. Tem-se estudado se a acurácia do diagnóstico laboratorial da síndrome poderia ser melhorada por meio da testagem de anticorpos antifosfolípides não critério. Neste trabalho revisamos a evidência a respeito das associações clínicas e valor diagnóstico dos anticorpos não critério mais estudados, nomeadamente: anticorpos antifosfatidiletanolamina, antianexina A5, antiprotrombina, anticomplexo fosfatidilserina/protrombina, IgA anticardiolipina e IgG antidomínio I da anti-β2 glicoproteína I.

Clinical study of Jiawei-Cuyun Decoction on autoimmunity recurrent spontaneous abortion in recurrent spontaneous abortion / 国际中医中药杂志

Objective@#To observe the effect of Jiawei-Cuyun Decoction on autoimmunity recurrent spontaneous abortion in recurrent spontaneous abortion.@*Methods@#To include eighty patients with autoimmunity recurrent spontaneous abortion from January 2016 to January 2018 in our hospital. The patients were divided into treatment group (36 cases) and control group (44 cases). The control group was treated with aspirin, and the treatment group was treated with Jiawei-Cuyun Decoction. The two groups, who were in the menstrual cycle, both were treated for 5 days until menstruation ends. The course of treatment for pregnancy should be no more than 3 menstrual cycles, and after pregnancy, the treatment should continue until the end of 12 weeks of pregnancy. During three menstrual cycles, the pregnancy serum anticardiolipin (aCL), anti-β2-1 glycoprotein (aβ2GP1) IgG and IgM were detected, and the adverse of drugs and pregnancy outcomes were recorded.@*Results@#For the third menstrual cycle, the overcast rates of serum aCL IgG [94.4% (34/36) vs. 68.2% (30/44); χ2=5.501, P=0.019], IgM [94.4% (34/36) vs. 77.3% (34/44); χ2=4.579, P=0.032], aβ2GP1 IgG [94.4% (34/36) vs. 75.0% (33/44); χ2=4.165, P=0.041], IgM [97.2% (35/36) vs. 79.5% (35/44); χ2=4.156, P=0.042] in the treatment group were significantly higher than those in the control group. After the treatment, the incidence of adverse reactions of the treatment group was 5.6% (2/36), and the control group was 31.8% (14/44), which showed that there was statistically significant difference between two groups (χ2=8.535, P=0.004). Pregnancy success rate of treatment group was 80.6% (29/36), and the control group was 56.8% (25/44), which showed that there was statistically significant difference between two groups (χ2=4.061, P=0.044).@*Conclusions@#Jiawei-Cuyun Decoction can effectively reduce the aCL, aβ2GP1 is IgG and IgM positive expression, reduce adverse drug reactions and improve the successful rate of pregnancy.

Research progress of relationship between anticardiolipin antibody and ischemic stroke / 心血管康复医学杂志

Ischemic stroke is a most frequent type of cerebrovascular disease .In recent years ,along with continuous deepening research on cause of cerebrovascular diseases ,autoimmune—mediated cerebrovascular diseases receive a lot of attention .Researches have found that anticardiolipin antibody (ACA) plays an important role in pathogenesis of ischemic stroke .The present article made following review on relationship between ACA and ischemic stroke and its current situation of research .

Clinical Phenotype of a First Unprovoked Acute Pulmonary Embolism Associated with Antiphospholipid Antibody Syndrome / 결핵및호흡기질환

BACKGROUND: Antiphospholipid antibody syndrome (APS), an important cause of acquired thrombophilia, is diagnosed when vascular thrombosis or pregnancy morbidity occurs with persistently positive antiphospholipid antibodies (aPL). APS is a risk factor for unprovoked recurrence of pulmonary embolism (PE). Performing laboratory testing for aPL after a first unprovoked acute PE is controversial. We investigated if a specific phenotype existed in patients with unprovoked with acute PE, suggesting the need to evaluate them for APS. METHODS: We retrospectively reviewed patients with PE and APS (n=24) and those with unprovoked PE with aPL negative (n=44), evaluated 2006–2016 at the Asan Medical Center. We compared patient demographics, clinical manifestations, laboratory findings, and radiological findings between the groups. RESULTS: On multivariate logistic regression analysis, two models of independent risk factors for APS-PE were suggested. Model I included hemoptysis (odds ratio [OR], 12.897; 95% confidence interval [CI], 1.025–162.343), low PE severity index (OR, 0.948; 95% CI, 0.917–0.979), and activated partial thromboplastin time (aPTT; OR, 1.166; 95% CI, 1.040–1.307). Model II included age (OR, 0.930; 95% CI, 0.893–0.969) and aPTT (OR, 1.104; 95% CI, 1.000–1.217). CONCLUSION: We conclude that patients with first unprovoked PE with hemoptysis and are age <40; have a low pulmonary embolism severity index, especially in risk class I–II; and/or prolonged aPTT (above 75th percentile of the reference interval), should be suspected of having APS, and undergo laboratory testing for aPL.

The antiphospholipid antibodies and pathological pregnancy / 中华检验医学杂志

Antiphospholipid antibody is a kind of autoantibodies that can react with different phospholipid components of the body .Many researches have suggested that antiphospholipid antibody can lead to many pathological pregnancies such as recurrent miscarriage , premature birth, stillbirth, pre-eclampsia by promoting placental thrombosis , damaging the functions trophoblast cells and many other pathways.Appropriate anticoagulation and immunotherapy in patients with pathological pregnancy induced by antiphospholipid antibodies can significantly improve the outcome of pregnancy .

Clinical analysis of 12 patients with pediatric antiphospholipid syndrome with pulmonary embolism / 中华儿科杂志

Objective@#To identify the clinical and immunological characteristics of pediatric antiphospholipid syndrome (APS) patients with pulmonary embolism.@*Method@#Among 47 pediatric APS patients from Peking Union Medical College Hospital during the year of 2000 to 2015, 12 patients were diagnosed of pulmonary embolism, who were investigated and compared with APS patients without pulmonary embolism.@*Result@#Twelve patients (among whom 6 cases were primary and the other 6 were secondary APS)had pulmonary embolism and all of them were non-shock type, which was the first presenting manifestation in 6 of them.Eight cases were misdiagnosed as infection, while 3 cases were missed.Among patients with pulmonary embolism, 10 patients suffered from deep vein thrombosis at the same time, mainly in lower extremities.2 cases had thrombotic recurrence, which happened only in primary APS patients, because of irregular monitoring of International Normalized Ratio, or not taking aspirin after quitting warfarin.Positive anticardiolipin (ACL) and lupus anticoagulant (LA) were found in 10 and 9 patients respectively.Four primary APS patients had positive anti-nuclear antibodies (ANA). During follow-up of 3-100 months (median 23 months) of primary APS, no one had evolved manifestations of systemic lupus erythematosus.Primary APS was more often seen in males (M∶F 5∶1 vs. 0∶6) and the patients were much younger ((15±1) vs. (17±0) years old) than those with secondary APS.Besides that, no statistically significant difference was seen between primary and secondary APS (P all>0.05). Compared with APS patients without pulmonary embolism, pulmonary hypertension was more common in patients suffered from pulmonary embolism (3/12 vs. 0, P<0.05).@*Conclusion@#Pulmonary embolism can be the first symptom in pediatric APS patients and all of them are non-shock type, which tends to be misdiagnosed or missed. A majority of them suffer from deep vein thrombosis in the lower extremities.Rethrombosis takes place when the anticoagulant therapy is irregular.Positive anti-nuclear antibodies can be seen in primary APS patients, but no manifestations of lupus come out during follow-up.There is no significant difference between primary APS and secondary APS.Pulmonary hypertension is more common in APS patients suffered from pulmonary embolism.

Lúpus eritematoso sistêmico e gravidez: uma revisão da literatura / Lupus erythematosus and pregnancy: a review of the literature

INTRODUÇÃO: O lúpus eritematoso sistêmico (LES) é uma doença autoimune, crônica, com envolvimento variável dos órgãos, principalmente pele e articulações, que afeta, predominantemente, mulheres jovens em idade reprodutiva associação do lúpus eritematoso sistêmico e gravidez é relativamente frequente, uma vez que não há diminuição da fertilidade nas pacientes. OBJETIVOS: Revisar as evidências disponíveis na literatura a cerca das situações clínicas e complicações que podem ocorrer durante o período gestacional de pacientes com lúpus eritematoso sistêmico, como a Síndrome do Anticorpo Antifosfolípide (SAF), a nefrite lúpica e o lúpus neonatal, a correlação entre a atividade do lúpus eritematoso sistêmico e a gravidez, além do uso de medicamentos no período da gestação. MÉTODOS: Foram utilizados banco de dados da Medline, Lilacs, Conchrane, Science Direct e PubMed, fazendo a seleção de artigos de revisão e estudos clínicos randomizados. Foram selecionados 23 artigos dos últimos 10 anos, sendo 21 na língua inglesa e 2 na língua portuguesa, seguindo a classificação Qualis (Capes): A1, A2 e B1. RESULTADOS: Estudos demonstraram a o impacto negativo da gravidez sobre a atividade da doença. Abortamento, natimorto, bebês pequenos para a idade gestacional, prematuridade e pré-eclâmpsia são as principais complicações que podem ocorrer na gestação de paciente com lúpus eritematoso sistêmico. As principais complicações relacionadas à Síndrome do Anticorpo Antifosfolípide relatadas na literatura foram aborto fetal precoce, início precoce de pré-eclâmpsia, retardo do crescimento intrauterino, descolamento prematuro da placenta e parto prematuro. Em relação aos medicamentos, os estudos apontam para a necessidade do uso da aspirina e da heparina de baixo peso molecular para a profilaxia de complicações da Síndrome do Anticorpo Antifosfolípide na gravidez, além do uso dos corticosteroides fluorados para o tratamento da doença em atividade. O uso da hidroxicloroquina em caso de atividade da doença durante a gestação também está indicado. Foram encontradas divergências quanto ao uso da azatioprina e da ciclofosfamida, havendo consenso quanto à contraindicação do metotrexato. CONCLUSÃO: A exacerbação do lúpus eritematoso sistêmico ocorre principalmente quando a doença não está bem controlada, sendo importante o aconselhamento destas pacientes, para que a concepção ocorra apenas quando o lúpus eritematoso sistêmico estiver inativo por pelo menos seis meses. O lúpus A nefrite lúpica, o lúpus neonatal e Síndrome do Anticorpo Antifosfolípide são condições que podem estar presentes em gestação de paciente com lúpus eritematoso sistêmico. A hidroxicloroquina não deve ser interrompida para que não haja exacerbação da doença. A maioria dos imunossupressores, como o metrotrexato e a ciclofosfamida, são contraindicados na gravidez.

INTRODUCTION: The systemic lupus erithematosus (SLE) is a autoimmune disease, chronic, with variable involvement of organs, especially skin and joints, which predominantly affects young women of reproductive age. The association of Systemic Lupus Erithematosus and pregnancy is relatively frequent, since there is no decrease in patients fertility. GOALS: Review the evidence in the literature about the clinical situations and complications that can occur during pregnancy in patients with Systemic Lupus Erithematosus, like the Antiphospholipid Antibody Syndrome (APS), thelupus nephritis and the neonatal lupus, the correlation between the activity of lupus and pregnancy, besides the use of drugs in the period of gestation. METHODS: Were used database from Medline, Lilacs, Cochrane, Science Direct and PubMed, making the selection of review articles and randomized clinical trials. Twenty-three articles were select, published over the past 10 years, with 21 in the English language and 2 in Portuguese, following the Qualis classification (Capes): A1, A2 e B1. RESULTS: Most articles show a negative impact of pregnancy on the disease activity. Abortion, stillbirth, small babies for the gestational age, preterm birth and preeclampsia are the major complications that may occur in pregnant patients with Systemic Lupus Erithematosus. Major complications related to APS in the literature were early miscarriage, early onset preeclampsia, intrauterine growth retardation, placental abruption and preterm delivery. Among medications used to treat Systemic Lupus Erithematosus and related diseases, aspirin and low molecular weight heparin may be used for the prophylaxis of complications of Antiphospholipid Antibody Syndrome and fluorinated corticosteroids for the reatment of disease activity. Hydroxychloroquine is also indicated to treat Systemic Lupus Erithematosus exacerbation during pregnancy. Differences were found, regarding the use of azathioprine and cyclophosphamide. However there is consensus regarding the contraindication of methotrexate. CONCLUSIONS: The exacerbation of Systemic Lupus Erithematosus occurs mainly when it is not well controlled. Being important the counseling of these patients that conception should occur at least after 6 months of inactivity. Nephritis, neonatal lupus and Antiphospholipid Antibody Syndrome are conditions that may be present in pregnant women with Systemic Lupus Erithematosus. Hydroxychloroquine should not be interrupted in order to prevent exacerbation of Systemic Lupus Erithematosus. The majority of immunosuppressive drugs such as cyclophosphamide and methotrexate, are contraindicated in pregnancy.