rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-353-359rsp-3184Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHАнтитела к домену I β 2-гликопротеина 1 у пациентов с антифосфолипидным синдромом и системной красной волчанкойAntibodies to domain I β2 -glycoprotein 1 in patients with antiphospholipid syndrome and systemic lupus erythematosushttps://orcid.org/0000-0001-5217-4932ЧельдиеваФ. А.CheldievaF. A.

115522, Москва, Каширское шоссе, 34а;

125993, Москва, ул. Баррикадная, 2/1, стр. 1

115522, Moscow, Kashirskoye Highway, 34A;

125993, Moscow, Barrikadnaya str., 2/1, building 1 

https://orcid.org/0000-0003-3552-2522РешетнякТ. М.ReshetnyakT. M.

115522, Москва, Каширское шоссе, 34а;

125993, Москва, ул. Баррикадная, 2/1, стр. 1

115522, Moscow, Kashirskoye Highway, 34A;

125993, Moscow, Barrikadnaya str., 2/1, building 1 

t_reshetnyak@yahoo.comhttps://orcid.org/0000-0002-3246-1157ЧеркасоваМ. В.CherkasovaM. V.

115522, Москва, Каширское шоссе, 34а 

115522, Moscow, Kashirskoye Highway, 34A 

https://orcid.org/0000-0002-4285-0869ГлуховаС. И.GlukhovaS. I.

115522, Москва, Каширское шоссе, 34а 

115522, Moscow, Kashirskoye Highway, 34A 

https://orcid.org/0000-0002-6068-3080ЛилаА. М.LilaA. M.

115522, Москва, Каширское шоссе, 34а;

125993, Москва, ул. Баррикадная, 2/1, стр. 1

115522, Moscow, Kashirskoye Highway, 34A;

125993, Moscow, Barrikadnaya str., 2/1, building 1 

https://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

115522, Москва, Каширское шоссе, 34а;

119991, Москва, ул. Трубецкая, 8, стр. 2

115522, Moscow, Kashirskoye Highway, 34A;

119991, Moscow, Trubetskaya str., 8, building 2

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian FederationRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияV.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)Russian Federation202209072022603353359Copyright © Чельдиева Ф.А., Решетняк Т.М., Черкасова М.В., Глухова С.И., Лила А.М., Насонов Е.Л., 20222022Чельдиева Ф.А., Решетняк Т.М., Черкасова М.В., Глухова С.И., Лила А.М., Насонов Е.Л.Cheldieva F.A., Reshetnyak T.M., Cherkasova M.V., Glukhova S.I., Lila A.M., Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3184

Цель исследования – определить клиническую значимость IgG-антител к домену I β2 -гликопротеина 1 (анти-β2 -ГП1DI), не входящих в классификационные критерии, при антифосфолипидном синдроме (АФС) в сочетании с системной красной волчанкой (СКВ) и при первичном АФС (пАФС).

Материалы и методы

Материалы и методы. В основную группу были включены 187 пациентов, имевших пАФС, АФС в сочетании с СКВ либо СКВ без АФС: 52 пациента – с пАФС; 12 – с «вероятным» АФС; 59 – с СКВ+АФС; 64 – с СКВ без АФС. В группу сравнения вошли 49 пациентов с амбулаторного приёма с направительным диагнозом АФС, который не был подтвержден. 100 относительно здоровых лиц составили группу контроля. Пациентам с пАФС, АФС+СКВ и СКВ без АФС проводилось определение IgG/IgM-антител к кардиолипину и IgG/IgMантител к β2 -гликопротеину 1 с использованием иммуноферментного анализа. У всех пациентов и в группе контроля определялось содержание IgG анти-β2 -ГП1DI с помощью хемилюминесцентного анализа.

Результаты

Результаты. IgG анти-β2 -ГП1DI выявлялись у 37 (71%) из 52 пациентов с первичным пАФС, у 6 (50%) из 12 пациентов с вероятным АФС, у 42 (71%) из 59 пациентов с СКВ+АФС, у 17 (26%) из 64 пациентов с СКВ, у 1 (2%) пациента из группы сравнения и ни у одного – из группы контроля. При пАФС и СКВ+АФС IgG анти-β2 -ГП1DI встречались статистически значимо чаще, чем при СКВ без АФС (р=0,0002 и р=0,0001 соответственно). Выявлена взаимосвязь анти-β2 -ГП1DI с клиническими проявлениями АФС (тромбозами (р=0,001) и акушерской патологией (р=0,04)). Позитивные значения IgG антиβ2 -ГП1DI статистически значимо чаще выявлялись у пациентов с артериальными тромбозами (р=0,002) и с акушерской патологией на поздних сроках гестации (р=0,01). Отмечается высокая специфичность анти-β2 -ГП1DI для диагноза и клинических проявлений АФС несмотря на низкую чувствительность: специфичность для тромбозов составила 84%, для акушерской патологии – 94%, для диагноза АФС – 89%. Изолированная позитивность по IgG анти-β2 -ГП1DI выявлялась редко (в 2% случаев) и не ассоциировалась с проявлениями АФС.

Заключение

Заключение. Частота выявления IgG анти-β2 -ГП1DI у пациентов с АФС была выше, чем при СКВ без АФС, в группе сравнения и в контроле. Позитивные значения IgG анти-β2 -ГП1DI статистически значимо ассоциировались с тромботическими осложнениями и с акушерской патологией. Специфичность IgG анти-β2 - ГП1DI для АФС и его клинических проявлений (тромбозов и акушерской патологии) была выше чувствительности и составляла 89%, 84% и 94% соответственно. 

The study of antiphospholipid antibodies (aPL), not included in the Sydney diagnostic criteria, in antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) is poorly understood.

The aim of this study – to determine the clinical significance of IgG antibody testing for domain I β2 -glycoprotein 1 (β2 -GP1DI) – IgG anti-β2 -GP1DI in patients with APS with and without SLE.

Materials and methods

Materials and methods. The study included 187 patients with APS with or without SLE, 49 patients formed a comparison group, and 100 relatively healthy individuals formed a control group. IgG/IgM antibodies to cardiolipin and IgG/ IgM anti-β2 -GP1 were determined by enzyme immunoassay (ELISA) in patients with or without APS, and IgG antiβ2 -GP1DI was determined by chemiluminescence assay in all patients and controls.

Results

Results. IgG anti-β2 -GP1DI was detected in 37 (71%) of 52 patients with primary APS (PAPS), in 6 (50%) of 12 patients with probable APS, in 42 (71%) of 59 patients with SLE+APS, in 17 (26%) of 64 patients with SLE, in 1 (2%) of comparison group and in none of control group. IgG anti-β2 -GP1DI was significantly associated with PAPS and SLE+APS compared with patients with SLE (p=0.0002 and p=0.0001, respectively). The association of IgG anti-β2 -GP1DI with clinical manifestations of APS (thrombosis (χ2 =9.69; p=0.001) and obstetric pathology (χ2 =4.19; p=0.04)) was detected. There was a significant association of IgG anti-β2 -GP1DI with arterial thrombosis (χ2 =8.84; p=0.002) and with late gestational obstetric pathology (χ2 =6.35; p=0.01). High specificity of IgG anti-β2 - GP1DI depending on the diagnosis and clinical manifestations of APS was noted despite low sensitivity: specificity for thrombosis was 84%, for obstetric pathology – 94%, for APS – 89%. Isolated IgG anti-β2 -GP1DI positivity was reported in 2% of 50 aPL negative patients and was not associated with APS manifestations.

Conclusion

Conclusion. The frequency of IgG anti-β2 -GP1DI detection was higher in patients with APS compared to patients with SLE, comparison group and control (p<0.05). Positive IgG anti-β2 -GP1DI values were significantly associated with thrombotic complications and with obstetric pathology (χ2 =8.84; p=0.002 and χ2 =6.35; p=0.01). Specificity>˂ 0.05). Positive IgG anti-β2 -GP1DI values were significantly associated with thrombotic complications and with obstetric pathology (χ2 =8.84; p=0.002 and χ2 =6.35; p=0.01). Specificity of IgG anti-β2 -GP1DI for APS and its clinical manifestations (thrombosis and obstetric pathology) was higher than sensitivity: 89%, 94%, and 84%, respectively. 

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The authors declare that there are no conflicts of interest present.