Detection of anticardiolipin antibody IgG by time-resolved fluoroimmunoassay

In an effort to improve the quantitative detection of anticardiolipin antibodies (aCL) IgG so as to classify patients correctly as antiphospholipid syndrome (APS) positive, we developed a new immunoassay based on a sandwich time-resolved fluoroimmunoassay (TRFIA) using the complex of cardiolipin plus bovine β₂GPI as antigen and Eu³⁺-labeled rabbit antihuman IgG as conjugate. The precision, sensitivity, specificity, and stability of the assay were evaluated, and comparison with the classical ELISA was also made. The aCL IgG TRFIA kit we established had a wider detectable range than three commercial ELISA ones from different manufacturers when a specimen was diluted, with strong positive result from 1:12.5 to 1:204,800. The average intra-assay and inter-assay CVs detected by the aCL IgG TRFIA was 3.14 and 3.70?%, respectively. The sensitivity was 0.1?GPL?U/ml, and the clinical diagnostic specificity was 98?%. The established assay kit also behaved better in stability than the commercial ELISA ones. Additionally, the immunoassay we established correlated well with the ELISA, and the correlation coefficient was 0.975. We thus conclude that the TRFIA we developed for aCL IgG detection gives promise to a more sensitive and reliable diagnosis of APS and has potential value for large-scale screening programs.     

Well-imaged large vessel vasculitis attributed to anticardiolipin antibody

Objective. We report a case of large vessel vasculitis, compare imaging techniques, and briefly review the literature. Methods. Anticardiolipin antibody titers, acute-phase response, and ischemic symptoms in a 50-year-old man admitted for treatment of vasculitis-related ischemia of the fingers were monitored over a 14-month period. Images from serial magnetic resonance angiography (MRA) were compared with images from conventional arteriography in the evaluation of peripheral arterial circulation. Results. The acute-phase response and anticardiolipin antibody levels were found to vary in parallel with slow resolution of ischemic symptoms following monthly treatment with pulse methylprednisolone and cyclophosphamide. Conclusion. Attribution of ischemic symptoms to anticardiolipin antibody is supported by the correlation of anticardiolipin antibody titers, acute-phase response parameters, and ischemic symptoms. The serial images from MRA demonstrate its usefulness as a noninvasive tool for followup studies of both large and medium-sized vessels affected by vasculitis.     

Massive pulmonary embolism secondary to anticardiolipin antibody syndrome

Antiphospholipid antibody syndrome, also known as Hughes syndrome, is a hypercoagulable disorder that increases the risk of recurrent vascular thrombosis. We present a case of 26-year-old female who developed massive bilateral pulmonary emboli after being started on oral contraceptive pills. Further work-up of the patient revealed that she had anticardiolipin antibody syndrome and the thrombotic event was precipitated by oral contraceptive pills.     

IgG and IgM anticardiolipin antibodies in patients with lupus with anticardiolipin antibody associated clinical syndromes

IgG and IgM anticardiolipin antibodies (aCL) were measured by a solid phase enzyme immunoassay in 64 patients with systemic lupus erythematosus who had one or more clinical disorders reported to be associated with aCL. We found the presence of IgG aCL was significantly associated with an increased incidence of cerebrovascular disease (p less than 0.01), a positive Venereal Disease Research Laboratories (VDRL) test (p less than 0.02) and prolonged partial thromboplastin time (PTT) (p less than 0.001). IgM aCL were associated with recurrent spontaneous abortion (p less than 0.05), thrombocytopenia (p less than 0.05) as well as a positive VDRL and prolonged PTT. The combination of high titer IgG and IgM aCL was associated with endocardial disease (p = 0.02), migraine (p less than 0.02), in addition to fetal loss (p less than 0.001).     

Plantar venous thrombosis and anticardiolipin antibody syndrome. Case report

We report a case of isolated plantar venous thrombosis in a young female with no recent history of surgery or trauma who complained of spontaneous left talalgia. She was treated with aspirin for a lupus anticoagulant. The diagnosis was established on the basis of color duplex ultrasonography. The patient was given long-term oral anticoagulants in accordance with international recommendations. Veins other than the usually examined regions, such as plantar veins, should be explored in patients with a known thrombophilic condition who present spontaneous talalgia. Presence of an isolated plantar venous thrombus in a patient with no known coagulation abnormality is suggestive of thrombophilic disease.     

Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report

Rationale:Idiopathic hypertrophic pachymeningitis (IHP) is a rare neurological disorder without a definite etiology. Diagnosis is mainly based on exclusion of other etiologies.Patient concerns:A 41-year-old male patient presented with insidious onset headache of 3-month duration.Diagnoses:Contrast-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement over bilateral cerebral hemispheres and the tentorium cerebelli. Lumbar puncture showed increased pressure, lymphocytic pleocytosis, and elevated protein level with normal glucose concentration. Blood tests detected elevated erythrocyte sedimentation rate (ESR) and C-reactive protein. Pathological examination of the dura mater from the right frontal convexity disclosed coarse collagenous deposition with focal lymphoid aggregation. After malignancy and infectious etiologies were excluded, a diagnosis of IHP was made.Interventions:Oral prednisolone and azathioprine followed by methotrexate were administered.Outcomes:During the 7-year follow-up period, although the patient was not totally headache-free, medical therapy significantly reduced the severity of headache. Follow-up MRI studies showed a reduction in meningeal enhancement and serial ESR measurements revealed a trend of improvement.Lessons:Methotrexate therapy may be considered in cases of steroid-resistant IHP. In addition to clinical evaluation, serial ESR testing may be considered to guide the treatment strategy and assess the response to therapy.     

抗心磷脂抗体阳性的急性缺血性脑血管病的临床特点

目的探讨抗心磷脂抗体(anti cardiolipin antibodies,ACA)阳性的急性缺血性脑血管病患者的临床特点。方法选择初发急性缺血性脑血管病患者46例,于入院时和发病后6周,采用酶联免疫吸附试验法测定ACA-IgM、ACA-IgG。根据测定结果将患者分为ACA( )组(16例)和ACA(-)组(30例),比较两组患者既往病史、个人史(吸烟、饮酒)、实验室和影像学检查资料;观察治疗中及发病后3、6、9、12个月脑血管病再发情况。结果①ACA( )组有糖尿病、高血压、吸烟史的患者比例明显低于ACA(-)组,差异有统计学意义(P<0.05或<0.01);②ACA( )组首次发病平均年龄、血浆纤维蛋白、全血低切黏度分别为(47±4)岁、(5.5±0.8)g/L、(21±3)mPa/s;ACA(-)组分别为(65±8)岁、(3.8±1.5)g/L、(17±4)mPa/s。两组比较差异有统计学意义(P<0.05或<0.01);③ACA( )组有9例(9/16)在磁共振弥散加权成像上显示存在2个以上新鲜病灶,14例(14/16)颈动脉超声显示多发低回声斑块,10例(10/15)DSA或MRA显示动脉多处狭窄;而ACA(-)组以上检查阳性数分别为3例(3/30)、6例(6/30)和5例(5/27),两组比较差异有统计学意义(P<0.05或<0.01);④治疗中和治疗后6、12个月疾病再发比例ACA( )组分别为4/16、6/14和8/12;ACA(-)组为1/30、3/28和5/19,两组比较差异均有统计学意义(P<0.05)。结论ACA阳性患者常缺乏脑梗死常见危险因素,初次发病年龄较小,伴有动脉内膜多发不稳定性斑块和血浆纤维蛋白原增高,短期内易再发新梗死。     

乙型肝炎病毒感染者血清抗心磷脂抗体检测结果分析

目的了解抗心磷脂抗体（ACA）在乙型肝炎病毒（HBV）感染者血清中的分布及检出情况。方法采用金标法检测158例HBV感染者（HBV感染组）和150名正常对照者（正常对照组）血清ACA。结果HBV感染者的ACA阳性率显著高于正常对照组（P〈0．01）,肝功能异常的HBV感染者ACA阳性率显著高于肝功能正常的HBV感染者（P〈0．01）。结论ACA可在HBV感染者血清中检出,其滴度高低与病情严重程度有一定关系。     

抗心磷脂抗体与老年高血压危险度分层的关系

目的通过观察不同严重程度(即不同危险度分层)的老年高血压患者血清中抗心磷脂抗体(ACLA)水平及D-二聚体(D-D)的变化,旨在了解ACLA在高血压发生发展中的临床意义。方法采用酶联免疫吸附法检测年龄≥60岁的120例高血压患者和30例健康者以及20例年龄<60岁健康者的ACLA和D-D水平,对不同危险度分层的老年高血压病患者上述指标进行比较。结果老年高血压中危、高危、极高危组的ACLA和D-D水平与健康组、低危组比较明显升高(P<0.05,P<0.01),低危组与健康对照组的ACLA和D-D水平比较无统计学差异(P>0.05),年龄≥75岁与<75岁的两组健康者比较ACLA和D-D水平比较有统计学差异(P<0.05)。结论高血压患者可能存在自身免疫,ACLA的测定对预测高血压病情轻重及并发症发生有一定的临床意义。     

Occlusive vasculopathy in systemic lupus erythematosus. Association with anticardiolipin antibody

Patients with systemic lupus erythematosus and with antiphospholipid antibody are subject to sudden occlusion of multiple blood vessels. We describe two patients with systemic lupus erythematosus with acute, catastrophic, widespread non-inflammatory visceral vascular occlusions associated with high-titer antiphospholipid antibody. The histopathologic features clearly distinguished these patients from classic systemic lupus erythematosus vasculitis. We further suggest that, based on a probable pathogenesis related to the presence of antiphospholipid antibody, and based on the non-inflammatory vascular occlusion, steroids and other immunosuppressive medications are of limited value. Plasmapheresis along with anticoagulant therapy should be considered.     

抗心磷脂抗体与ST段抬高型心肌梗死PCI术后心脏扩大的相关性研究

目的探讨抗心磷脂抗体（ACLA）与ST段抬高型心肌梗死PCI术后心脏扩大及心功能不全的临床关系。方法145例ST段抬高型心肌梗死患者于发病1周行PCI手术,3个月后测定抗心磷脂抗体,复查超声心动图,检测左心房（LA）、左心室（LV）、射血分数（EF）、二尖瓣E峰峰值流速／二尖瓣A峰峰值流速（E／A）等值。结果AcLA—I蜘和ACLA—IgM水平,无心脏扩大心梗组为0．90±0．22和0．98±0．24,显著高于健康对照组的0．80±0．38和0．84±0．36（P〈0．05）;有心脏扩大心梗组为1．16±0．31和1．29±0．34,显著高于无心脏扩大心梗组（P〈0．05）。有心脏扩大心梗组AcLA阳性率为71．43％,显著高于无心脏扩大心梗组的40．45％（P〈0．05）。结论sT段抬高型心肌梗死PCI术后心脏扩大患者存在自身免疫机制,测定ACLA对预测sT段抬高型心肌梗死PCI术后心脏扩大以及心功能不全有一定的临床意义。     

Evaluation of hemostasis disorders and anticardiolipin antibody in patients with severe leptospirosis

A prospective study was designed to evaluate disorders of hemostasis and levels of anticardiolipin antibodies (ACL) in 30 patients with severe leptospirosis and acute renal failure (ARF) (ARF was defined as serum creatinine > or =1.5 mg/dL). The patients had been admitted to the Walter Cantídio University Hospital, S?o José Infectious Diseases Hospital and General Hospital of Fortaleza, Ceará, from August 1999 to July 2001. They all were male, with a mean age of 32 +/- 14 years and with clinical and laboratory diagnoses of ARF leptospirosis. The time elapsed between onset of symptoms and the first hemorrhagic manifestation was 9 +/- 4 days. Bleeding was observed in 86% of the patients. Laboratory tests showed significantly high levels of urea (181 +/-95 mg/dl), fibrinogen, (515 +/- 220 mg/dl), prothrombin time (13.3 +/- 0.9 seconds) and low platelet counts (69 +/- 65 x 10(3)/mm3) on admission. There was no elevation in activated partial thromboplastin time or thrombin time. Levels of IgM and IgG ACL concentrations were significantly increased (p < 0.05) in leptospirosis patients when compared to control patients (28.5 +/- 32.4 vs. 11.5 +/- 7.9MPL U/ml and 36.7 +/- 36.1 vs. 6.5 +/- 2.5 GPL U/ml), respectively. Vasculitis, thrombocytopenia and uremia should be considered important factors for the pathogenesis of hemorrhagic disturbances and the main cause of death in severe leptospirosis.