目的 探讨系统性红斑狼疮(SLE)患者中活化蛋白C抵抗(APCR)现象及英临床意义.方法 分别检测加活化蛋白C(APC)和不加APC的血浆的凝血时间CT1和CT2,计算CT2/CTI,规定CT2/CT1≤1.8为APCR阳性,≥2.0为APCR阴性.结果 SLE患者中APCR阳性率为57.5％,且APCR阳性者均存在血栓所致系统损害.ApCR阳性组中狼疮肾炎的发生率明显高于APCR阴性组,而免疫球蛋白G型抗心磷脂抗体(ACA-IgG)阳性组与ACA-IgG阴性组中各系统损害的发生率无明显差异,但APCR、ACA-IgG均阳性的患者均存在动脉或静脉血栓.APCR与反映血栓形成指标D-二聚体和纤维蛋白原、反映肾脏病变程度指标24h尿蛋白定量、自身抗体(抗核抗体、抗双链DNA抗体和抗ENA抗体谱)均无相关性.结论 APCR可能是SLE患者诱发血栓的危险因素之一,ACA通过对蛋白C系统的间接抑制作用协同参与血栓形成过程,APCR的检测对预测SLE患者并发血栓可能更有价值.%Objective To study the phenomenon of activated protein C resistance (APCR) in patients with systemic lupus eiythematosus (SLE) and to explore its clinical significance. Methods Clotting time of CT1 and CT2 was obtained by measuring plasma with and without activated protein C, value of CT2/CT1 was calculated following that the set standards of being positive for CT2/CT1 ≤1.8 and negative for CT2/CT1 ≥ 2.0. Results The APCR positive rate of patients with SLE was 57.5% (23/40), and the patients in the positive group of APCR all had system damage caused by thrombosis. The incidence of the lupus nephritis in the positive group of APCR was obviously higher than that in the negative group. While there was no significant difference in the incidence of system damage between the positive group of im-munoglobulin G- anacardiophospholipid antibody (ACA-IgG) and the negative group,the patients with APCR and ACA-IgG positive had arterial or venous thrombosis. APCR was not closely correlated with D-diroer,Ebrinogen,24 hours total urine protein,anti-nuclear antibodies, anti-double-stranded DNA antibodies,anti-extractable nuclear antigens antibodies. Conclsuion APCR may be a risk factor for the induction of thrombosis in patients with SLE. ACA-IgG also takes part in the process of thrombosis by indirect inhibition of protein C system,the measurement of APCK may be significant in estimating the rate of thrombosis occurrence in patiente with SLE.
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