抗β2-GPI抗体与狼疮脑病患者的头痛和缺血性卒中发病密切相关
作者:Tomasz Hawro 翻译:北医三院李欣艺
摘要: 背景:神经精神性系统性红斑狼疮是狼疮常见并且潜在致命风险的临床表现。抗磷脂抗体如狼疮抗凝物、抗心磷脂抗体、β2-GPI,尤其是β2-GPI在神经性系统性红斑狼疮发病中起重要作用。但是,它们在狼疮脑病发病中所起的作用仍需进一步阐释。
方法/主要研究结果:57名狼疮患者(其中女性53名)纳入研究,其均进行2次的狼疮抗凝物、抗心磷脂抗体及β2-GPI的检测,确保这些患者上述抗体是持续阳性的。69名健康患者也进行上述检测作为对照组。上述狼疮患者中狼疮脑病发病率为74%。头疼是最主要的临床表现,占39%左右,其次是脑血管病变,占23%左右。抑郁占19%,癫痫发作占14%。狼疮脑病以及非狼疮脑病患者表现出相似的狼疮疾病活动度及激素使用。65%狼疮脑病发病先于狼疮疾病的诊断。狼疮脑病患者的抗磷脂抗体与非狼疮脑患者相似。头疼以及卒中与抗β2-GPI-IgM型相关,癫痫发作与抗β2-GPI-IgG型相关。
结论:狼疮患者的狼疮脑病比较频发,且常常早于狼疮疾病诊断之前出现。抗β2-GPI抗体与头痛、缺血性卒中相关,且与抗心磷脂抗体、狼疮抗凝物相比,其具有更好的阳性预测性。上述发现可能有助于提高狼疮脑病的诊断,更多关于抗β2-GPI抗体在狼疮脑病发病机制中作用的研究需要进行。
附原文:Background Neuropsychiatric systemic lupus erythematosus (NPSLE) is a common and potentially fatal manifestation of SLE. Antiphospholipid antibodies (aPL) such as lupus anticoagulant (LA), anticardiolipin (aCL) and antibodies to β2glycoprotein I (anti-β2GPI), the most important aPL antigen, are thought to play a role in some forms of NPSLE. As of yet, their specific roles in NPSLE manifestations remain to be elucidated. Methodology/Principal Findings 57 SLE patients (53 women) were assessed for LA, aCL and anti-β2GPI twice, to determine persistent positivity. All patients were examined by neurology and psychiatry specialists. 69 healthy subjects were assessed as controls. NPSLE was diagnosed in 74% of patients. Headaches were the most prevalent manifestation of NPSLE (39%), followed by cerebrovascular disease (CVD) (23%), depressive disorders (19.0%), and seizures (14%). NPSLE and non-NPSLE patients showed comparable SLE activity and corticosteroid use. In 65% of patients neuropsychiatric manifestations preceded SLE diagnosis. aPL profiles of NPSLE patients and non-NPSLE patients were similar. Headaches and ischemic stroke were independently associated with anti-β2GPI-IgM (OR=5.6; p<0 .05), and seizures were linked to anti-β2gpi-igg (or="11.3;" p="0.01)." conclusions in sle patients, neuropsychiatric manifestations occur frequently and early, often before the disease is diagnosed. autoantibodies to β2gpi are linked to non-specific headaches, ischemic stroke and seizures, and show a better predictive value than acl and la. these findings may help to improve the diagnosis of npsle and should prompt further studies to characterize the role of anti-β2gpi in the pathogenesis of this condition.
引自:Tomasz Hawro, Andrzej Bogucki, Maria Krupińska-Kun,Marcus Maurer and Anna Wo?niacka Intractable Headaches, Ischemic Stroke, and Seizures Are Linked to the Presence of Anti-β2GPI Antibodies in Patients with Systemic Lupus Erythematosus PLoS One. 2015; 10(3): e0119911