Antibodies to the phosphatidylserine/prothrombin complex in the diagnosis of antiphospholipid syndrome

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Abstract

Aim. To determine the significance of antibodies to the phosphatidylserine/prothrombin complex (aPS/PT) in patients with systemic lupus erythematosus (SLE) antiphospholipid syndrome (APS).

Materials and methods. A total of 190 patients were included in the study: 123 (64.7%) with reliable SLE and 55 (29%) with PAPS. The control group included 100 relatively healthy subjects of comparable age. All patients were tested for classical aPL as well as IgG/IgM-anti-PS/PT by enzyme immunoassay.

Results. Based on the average values of IgG/IgM aPS/PT of the control group, the levels of positivity were allocated mean (M) + 3 or 5 standard deviations (SD): M+3SD and M+5SD. IgG aPS/PT levels above 73.6 U/ml (M+5SD) were more accurate diagnostic, for IgM aPS/PT – above 18.0 U/ml. IgG-aPS/PT were detected in 84 (44%) of 190 patients. Levels above diagnostic levels were detected in 68 (65%) of 104 patients with APS (55 with PAPS and 59 with SLE+APS). Thrombosis was significantly more common in patients with IgG aPS/PT compared with patients negative for IgG aPS/PT. Arterial but not venous thrombosis was associated with IgG aPS/PT positivity.

Conclusion. The frequency of detection of IgG aPS/PT in the examined patients was 44%, IgM aPS/PT – 29% and their combination – 19% of 190 patients. Half of the patients with probable APS had positive IgG aPS/PT and third – IgM aPS/PT. Median IgG aPS/PT were significantly higher in patients with APS compared to patients without APS and the control group. Thrombosis was associated with IgG aPS/PT. Arterial thrombosis was significantly more frequently reported in patients with IgG aPS/PT. The sensitivity of IgG aPS/PT for reliable APS at levels greater than 73.6 units/ml was 59%, specificity – 92%, for IgM aPS/PT – 35% and 91%, respectively.

About the authors

Tatiana M. Reshetnyak

Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: t_reshetnyak@yahoo.com
ORCID iD: 0000-0003-3552-2522

д-р мед. наук, проф., зав. лаб. тромбовоспаления ФГБНУ «НИИ ревматологии им. В.А. Насоновой», проф. каф. ревматологии ФГБОУ ДПО РМАНПО

Russian Federation, Moscow; Moscow

Fariza A. Cheldieva

Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education

Email: t_reshetnyak@yahoo.com
ORCID iD: 0000-0001-5217-4932

мл. науч. сотр. лаб. тромбовоспаления ФГБНУ «НИИ ревматологии им. В.А. Насоновой», аспирант каф. ревматологии ФГБОУ ДПО РМАНПО

Russian Federation, Moscow; Moscow

Mariya V. Cherkasova

Nasonova Research Institute of Rheumatology

Email: t_reshetnyak@yahoo.com
ORCID iD: 0000-0002-3246-1157

канд. биол. наук, врач клинической лабораторной диагностики, науч. сотр. лаб. тромбовоспаления ФГБНУ «НИИ ревматологии им. В.А. Насоновой»

Russian Federation, Moscow

Aleksander M. Lila

Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education

Email: t_reshetnyak@yahoo.com
ORCID iD: 0000-0002-6068-3080

д-р мед. наук, проф., дир. ФГБНУ «НИИ ревматологии им. В.А. Насоновой», зав. каф. ревматологии ФГБОУ ДПО РМАНПО

Russian Federation, Moscow; Moscow

Evgeny L. Nasonov

Nasonova Research Institute of Rheumatology; Sechenov First Moscow State Medical University (Sechenov University)

Email: t_reshetnyak@yahoo.com
ORCID iD: 0000-0002-1598-8360

акад. РАН, д-р мед. наук, проф., науч. рук. ФГБНУ «НИИ ревматологии им. В.А. Насоновой», зав. каф. ревматологии ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)

Russian Federation, Moscow; Moscow

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2. Fig. 1. Median IgG-aFS/PT and IgM-aFS/PT in patients with and without antiphospholipid syndrome (APS).

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3. Fig. 2. Diagnostic value of IgG/IgM-aFS/PT depending on the presence of APS and its main clinical manifestations (ROC-curves): a – for thrombotic complications; b – for obstetric pathology; c – for the diagnosis of reliable antiphospholipid syndrome

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