The association of antibodies to beta 2 glycoprotein I with the antiphospholipid syndrome: a meta-analysis.

The precise target of marker autoantibodies in the antiphospholipid syndrome (APS) has been controversial. Recently, the theory that surface-bound beta 2 glycoprotein I (beta 2 GPI) presents a normally encrypted autoepitope and that antibodies to beta 2 GPI (anti-beta 2 GPI) are associated with APS, has been prominent. The literature has been searched from 1990 to 1995 (inclusive) to find studies in which: (1) anti-beta 2 GPI antibodies were measured and, (2) adequate clinical data describing the patients were included. These conditions were met in four studies, from August 1992 to December 1995, in which patient samples ranged from 15 to 39 cases, the total of the four studies being 90 cases. Applying the diagnostic criteria of > or = 2 clinical manifestations of APS, 65 cases had APS while 25 did not. For the group with APS, 58/65 (89 percent) were anti-beta 2 GPI (+); among those who did not meet the criteria, 11/25 (44 percent) were anti-beta 2 GPI (+) (p < 0.0001). The presence of either the primary (1 degree) or secondary (2 degrees) form of APS made no difference in association with anti-beta 2 GPI; 13/16 (81 percent) patients with 1 degree APS and 45/49 (92 percent) with 2 degrees APS had anti-beta 2 GPI. The presence of lupus anticoagulant (LAC) did not predict APS: 25/58 (38 percent) APS (+) cases were LAC (+); 11 APS (-) were all LC (+) (p < 0.0001). IgG anticardiolipin also showed a closer association with APS absence (25/25 cases; 100 percent) than with APS presence (40/65; 62 percent, p < 0.0001). These data support the contention that anti-beta 2 GPI antibodies are closely associated with APS and that their measurement may facilitate the diagnosis.