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ГЛАВА 7. Клинические проявления антифосфолипидного синдрома

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глава 8

КЛ И Н И Ч Е С К О Е З Н А Ч Е Н И Е

АН Т И Ф О С Ф О Л И П И Д Н Ы Х А Н Т И Т Е Л

фосфолипидам (аФЛ) представляют собой семейство ау распознающих антигенные детерминанты анионных и нейт фосфолипидов и комплексные эпитопы, образующиеся в про фосфолипидов и фосфолипидсвязывающих бел 8.1). После того как было установлено, что аФЛ реагиру

фосфолипидами, а с фосфолипидсвязывающими белками, неко предпочитают использовать термин "антитела к фосфоли

комплексу".

Спектр антител, выявляемых в сыворотке больных АФС2

при реакции Вассермана реакция Вассермана)

при определении аКЛ иммуноферментным методом

ФЛ связывающим белкам (?)

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ГЛАВА 8. Клиническое значение антифосфолипидных антител

аФЛ, выявляемые при определении ВА

кпротромбину

кβ2 ГП I

кфактору V

кфактору X

Антитела, не выявляемые с помощью стандартных методов определения аФЛ

кэндотелию (АЭКА)

кбелку C

кбелку S

ктромбомодулину

кгепарансульфату протеогликана/гепарину

каннексину V

кCD36

квысоко и низкомолекулярному кининогену

кфосфолипазе А2 (?)

коЛНП и другим липопротеинам

Биологическая ложноположительная реакция Вассермана

аФЛ, выявляемые стандартным методом, использующимся для диагнос тики сифилиса, — это первые аФЛ, обнаруженные при заболеваниях чело века. аФЛ при сифилисе отличаются от аФЛ при аутоиммунных заболева ниях, хотя нередко у одного и того же человека обнаруживают оба типа ан тител. При диагностике сифилиса чаще всего определяют так называемый Venereal Disease Research Laboratory антиген (VDRL антиген) или "реагино вый" антиген. VDRL антиген состоит из кардиолипина, фосфатидилхолина и холестерина в объемных соотношениях 1:10:30. Холестерин выполняет роль "стержня", вокруг которого слоями располагаются фосфатидилхолин и кардиолипин. Кардиолипин — основной антиген, с которым реагируют ан титела при сифилисе. Его антигенность зависит от двух фосфодиэфирных групп, разделенных тремя метиленовыми группами, и центральной гидро

ксильной группы. Холестерин, в отличие от фосфатидилхолина, который

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Насонов Е.Л. Антифосфолипидный синдром

определенную пространственную конфигурацию молекулы, обязательным компонентом "реагинового" антигена.

сыворотке больных АФС могут обнаруживаться антитела к VDRL (ложноположительная реакция Вассермана), но, как правило, в титре, в то время как при использовании "чистого" КЛ выявляет высокий уровень антител. Напротив, для сифилиса характерен титр антител к VDRL антигену, а реакция с "чистым" КЛ, иммо

на твердой фазе, нередко отсутствует. иммуноферментный или радиоиммунный методы, ис

в настоящее время для определения аКЛ, в 200—400 раз чувствительны, чем VDRL тест (реакция агглютинации). ИФМ, на использовании VDRL антигена, значительно более чув при обнаружении аКЛ в сыворотке больных сифилисом, чем

с "чистым" КЛ5. В исследованиях было показано, что кардиолипи липосомы абсорбируют аКЛ из сыворотки больных СКВ в боль чем VDRL липосомы, но последние лучше абсорбируют из сыворотки у больных сифилисом, чем у больных АФС. Кро

аКЛ, присутствующие в сыворотке больных сифилисом, лучше кардиолипин в составе VDRL антигена, чем "чистый" КЛ, реагируют с фосфатидилсерином и фосфатидилхолином. Таким различная частота выявления аКЛ при сифилисе и АФС связа с чувствительностью самих методов, а со свойствами антигена, рас соответствующими антителами. В настоящее время не рекомендуется использовать для определения аФЛ, по

этот тест обладает низкой чувствительностью и специфичнос Однако обнаружение ложноположительной реакции Вассермана показанием для определения аФЛ и, в случае положительных для динамического наблюдения за пациентами в отношении

развития АФС.

антикоагулянт (ВА)

АФС часто обнаруживают ВА — разновидность аФЛ, кото с белками плазмы (β2 ГП I, протромбин и аннексин V)

8.1). При скрининге для определения ВА можно использовать

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