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Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 1027-1032. doi: 10.19723/j.issn.1671-167X.2018.06.015

• Article • Previous Articles     Next Articles

Increased serum soluble-endoglin level and its clinical significance in antiphospholipid syndrome

Ji LI1,2,Li ZHENG1,Lian-jie SHI2,Jing XU2,Jian-long SHU3,Xue-wu ZHANG3,△()   

  1. 1. Department of Rheumatology and Immunology, Peking University People’ s Hospital, Beijing 100044, China
    2. Department of Rheumatology and Immunology, Peking University International Hospital, Beijing 102206, China
    3. Department of Rheumatology and Immunology, Guangxi International Zhuang Medical Hospital, Nanning 530011, China
  • Received:2018-07-10 Online:2018-12-18 Published:2018-12-18
  • Contact: Xue-wu ZHANG E-mail:xuewulore@163.com

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Abstract:

Objective: To detect the serum levels of soluble endothelial glycoprotein endoglin (s-Eng) in patients with antiphospholipid syndrome(APS) and to evaluate the correlation between s-Eng levels and clinical features and laboratory parameters.Methods:The levels of serum s-Eng were measured by enzyme linked immunosorbent assay ( ELISA) in 139 patients with APS, 44 patients with SLE but no APS, 37 patients with primary Sjogren’s syndrome (pSS), 23 patients with Bechet’s disease (BD), 22 patients with systemic sclerosis (SSc) and 22 persistent anticardiolipin antibody (aCL) positive indivi-duals without SLE or APS(simply aCL positive group) and 87 health controls(HC) without any auto-immune diseases. These APS patients included 64 primary APS patients and 75 APS patients secondary to SLE.The correlation between the clinical data, laboratory parameters, and serum s-Eng levels were analyzed.Independent samples t test,paired t test,Chi-square Test, Mann-Whitney U test, Pearson’s χ 2 test were used for statistical analyses. Results:(1)The serum levels of s-Eng were significantly higher in the patients with APS whether primary or secondary to SLE than in the health controls and simply aCL positive group and the patients with other autoimmune diseases, including SLE, pSS, BD and SSc(P<0.001).There was no significant difference in the serum s-Eng levels between simply aCL positive group and health controls[(5.17±2.00) mg/L vs.(5.04±1.11) mg/L, P>0.05]. (2) The best cut-off value for the diagnosis of APS was no less than 8.37 mg/L as mean ± 3SD value, with the sensitivity at 0.772 and the specificity at 0.928. The Youden index was 0.700. These results indicated good validity of s-Eng as a diagnostic marker for APS. (3)The proportions of artery thrombosis and pathological pregnancy were higher in the group of s-Eng -positive APS patients than that in s-Eng -negative group(46/81 vs. 19/58,29/65 vs. 10/44,respectively, all P<0.05).The levels of PLT were lower in the group of s-Eng-positive APS patients (72.00×10 9/L vs. 119.00×10 9/L, P<0.001). (4)The proportions of the presence(93.83% vs. 37.93%, P<0.001) and titer (61.70 U/mL vs.15.45 U/mL, P<0.001) of aCL were both higher in the group of s-Eng-positive APS patients than in s-Eng-negative group. The proportions of the presence (61.73% vs. 43.10%, P<0.05)and titer (33.48 U/mL vs.17.40 U/mL,P<0.05) of anti-β2-glycoproteinⅠ antibody were both higher in the group of s-Eng -positive APS patients than in s-Eng -negative group too. Conclusion:S-Eng serum levels were significantly increased in the patients with APS, and it may play a role as acomplementary serological marker for the diagnosis and risk prediction of APS.

Key words: Soluble endoglin, Antiphospholipid syndrome, Thrombosis, Pathological pregnancy, Antiphospholipid antibody

CLC Number: 

  • R593.2

Table 1

Clinical manifestation and laboratorycharacteristics of APS patients"

Parameter APS patients (n=139)
Demographic data
Age/years, x-±s 43.05±15.33
Disease duration/years, x-±s 4.35±2.92
Male / female 30/109
Clinical manifestation
Tarombokinesis 137/139 (98.56%)
Arterial thrombosis 65/139 (46.76%)
Venous thrombosis 96/139 (58.27%)
Microvascular thrombosis 15/139 (10.79%)
Obstetrical complications 39/109 (35.78%)
Dead fetus in uterus 22/109 (20.18%)
Spontaneous abortion ≥3 times 14/109 (9.17%)
Preeclampsia 3/109 (2.75%)
Laboratory characteristics
Hematological disease 67/139 (48.25%)
Thrombocytopenia 85/139 (61.2%)
Anemia 39/139 (60.43%)
ANA 84/139 (60.43%)
LA 15/24 (62.5%)
aCL 98/139 (70.50%)
Antiβ2-GPⅠ 75/139 (53.96%)

Figure 1

Serum s-Eng levels of APS patients, other rheumatic disease patients, simply aCL positive group and the health control* P <0.01;▲ P<0.001;s-Eng, soluble endoglin;APS, antiphospholipid syndrome;SLE, systemic lupus erythematosus;pSS, primary Sjogren’s syndrome;BD, Behcet’s disease;SSc, systemic sclerosis;ACL(+), anticardiolipin antibody positive;HC, health control."

Figure 2

Serum levels of s-Eng between patients with pAPS and APS secondary to SLEs-Eng, soluble endoglin;pAPS, primary antiphosphlipid syndrome;APS, antiphosphlipid syndrome;SLE, systemic lupus erythematosus;NS, no statistics."

Figure 3

ROC curves of s-Eng for identification of APS"

Table 2

Comparison of clinical and laboratory features between patients with positive s-Eng and those with negative s-Eng"

Parameter s-Eng(+) s-Eng(-) P
Demographic data
Age/years, x-±s 43.05±15.32 41.10±15.00 0.491
Disease duration /years, x-±s 4.42±3.17 4.20±2.22 0.686
Male/female 16/65 14/44 0.535
Clinical feature
Tarombokinesis 80/81 57/58 1.000
Arterial thrombosis 46/81 19/58 0.005
Venous thrombosis 59/81 37/58 0.255
Microvascular thrombosis 11/81 4/58 0.210
Obstetrical complications 29/65 10/44 0.019
Dead fetus in uterus 15/65 7/44 0.360
Spontaneous abortion ≥3 times 12/65 2/44 0.033
Preeclampsia 2/65 1/44 0.799
Laboratory examination
Hematological disease 63/81 26/58 <0.001
WBC(×109/L), x-±s 6.11±3.45 5.87±3.87 0.720
PLT(×109/L), M(P25,P75) 72.00 (52.00, 99.70) 119.00 (89.75, 162.70) <0.001
HGB/(g/L), x-±s 120.63±28.89 128.23±26.09 0.147
LA (+) 18/81 11/58 0.928
aCL (+) 76/81 22/58 <0.001
Antiβ2-GPⅠ (+) 50/81 25/58 0.030
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