루푸스항응고인자 검출을 위한 실리카응고시간의 유용성
Usefulness of Silica Clotting Time for Detection of Lupus Anticoagulants
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배경 : 루푸스항응고인자는 항인지질항체증후군에서의 혈전 증 예측에 유용한 검사이다. 본 연구에서는 루푸스항응고인자 검사 시 기존에 사용하고 있는 dilute Russell’s viper venom test (dRVVT) 방법에 최근 도입된 silica clotting time (SCT) 방법을 추가하는 경우의 유용성을 평가하고자 하였다. 또한 루 푸스항응고인자 검사 방법(dRVVT, SCT)에 따른 혈전증 양상 과 효소면역법으로 측정된 항인지질항체의 차이를 분석하고자 하였다. 방법 : 루푸스항응고인자 또는 anti-cardiolipin (anti-CL) 항체가 양성인 167명의 환자와 정상건강인 76명을 대상으로 하 였다. 루푸스항응고인자를 응고법인 dRVVT와 SCT 방법으로 측정하였으며, anti-CL 항체, anti-β2 glycoprotein I (anti-β2- GPI) 항체, 그리고 anti-prothrombin (anti-PT) 항체를 상품화된 효소면역법 키트를 이용하여 측정하였다. 결과 : 혈전증 예측에서의 민감도는 dRVVT에 SCT 방법을 추가하는 경우 56.4%로, dRVVT 방법 단독(46.2%)으로 또는 SCT 방법 단독(23.1%)으로 사용하는 경우보다 높았다. 특이도 는 dRVVT에 SCT 방법을 추가하는 경우 80.9%로 dRVVT를 단독 사용(81.9%) 하는 경우와 크게 차이가 나지 않았다. 또한 dRVVT 또는 SCT 방법을 단독으로 사용하는 경우에 비해, 두 가지 방법으로 루푸스항응고인자를 측정하는 경우 혈전증 예측 의 교차비가 더 높았다. dRVVT의 normalized ratio가 더 높았 던 군에 비해, SCT 방법의 normalized ratio가 더 높았던 군에서 반복 유산력이 유의하게 높았으며, 항인지질항체인 anti-CL, anti-β2 GPI, anti-PT의 IgG 형태의 양성률도 모두 유의하게 높았다. 결론 : 루푸스항응고인자 검사에서 dRVVT와 함께 SCT 방법 을 추가하는 경우 혈전증 예측의 민감도를 높일 수 있다. 또한, SCT의 normalized LA ratio가 높은 경우, 반복 유산력과 같은 산과적 합병증 판단에 더 유용한 변수로 생각된다.
Abstract
Background : The presence of lupus anticoagulants (LA) is a strong risk factor for thrombosis in antiphospholipid syndrome. We investigated the usefulness of addition of silica clotting time (SCT) to the pre-existing dilute Russell’s viper venom test (dRVVT) for detection of LA. Also, we analyzed differences in the thrombotic features and the characteristics of antiphospholipid antibodies between dRVVT and SCT. Methods : A total of 167 patients positive for LA or anti-cardiolipin (anti-CL) antibody and 76 healthy controls were enrolled. The dRVVT and SCT were used for detection of LA. Anti-CL, anti-β2-glycoprotein I (anti-β2 GPI) and anti-prothrombin (anti-PT) antibodies were measured using commercial ELISA kits. Results : In detection of thrombosis, the sensitivity of the combined test of SCT and dRVVT was 56.4%, which was higher than that of dRVVT alone (46.2%) or SCT alone (23.1%). The specificity of the combined test (80.9%) was comparable to that of dRVVT (81.9%). Also, odds ratio for predicting thrombosis was higher in the combined test than in dRVVT or SCT alone. When normalized LA ratio of the two tests was compared, the group of patients with higher ratio of SCT showed significantly higher prevalence of recurrent abortion and higher positivity of IgG types of anti-CL, anti-β2 GPI and anti-PT than the group with higher ratio of dRVVT. Conclusions : Addition of SCT to dRVVT can improve the detection sensitivity of thrombosis in LA test. And the high normalized LA ratio of SCT may be a useful parameter for detection of recurrent abortion.
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