Aguilar Franco C, Lucía Cuesta J
Servicio de Hematología. Hospital General del INSALUD. Soria.
An Esp Pediatr. 2001 May;54(5):444-9.
Findings of prolonged activated partial thromboplastin time (APTT) and lupus anticoagulant are rare in asymptomatic children and are often preceded by certain types of surgery. Clinical behaviour is usually favorable.
We assessed the biological and clinical features of antiphospholipid antibodies found in 13 children diagnosed between January 1996 and September 2000 (mean age at diagnosis: 5 years). The patients were prospectively followed-up for a median of 16 months (range: 15-60). The diagnosis of lupus anticoagulant was based on the guidelines of the International Society of Thrombosis and Hematosis and included coagulation-based assays as well as enzyme-linked immunosorbent assay for anticardiolipin and anti-beta 2 glycoprotein I.
In all patients lupus anticoagulant was detected after investigation of prolonged APTT prior to surgery (adenoidectomy in eight patients, orchidopexy in one and eye surgery in one). The antibody was associated with infectious mononucleosis in one patient and was detected during routine laboratory investigations in two. All antibodies were primary and 53.6% of events were transient. In all patients lupus anticoagulant IgG and anti-beta 2 glycoprotein I were negative. Slightly reduced factor XII:C plasma concentrations (mean: 38.2 UI/dl) were found in 30.7% of the patients. No clinical manifestations of antiphospholipid symptoms were associated with the diagnosis of antiphospholipid antibodies and none of the patients experienced bleeding after surgery.
Primary antiphospholipid antibodies were infrequent in asymptomatic pediatric patients and were typically associated with certain types of surgery (adenoidectomy, tonsillectomy) or viral infections. They were usually transient and clinically irrelevant. These antibodies may be associated with slightly reduced plasma concentrations of factor XII and consequently a differential diagnosis with a mild factor XII deficiency should be considered.
在无症状儿童中，活化部分凝血活酶时间（APTT）延长和狼疮抗凝物的发现较为罕见，且通常在某些类型的手术之前出现。临床行为通常良好。
我们评估了1996年1月至2000年9月期间确诊的13名儿童（诊断时平均年龄5岁）中抗磷脂抗体的生物学和临床特征。对患者进行前瞻性随访，中位随访时间为16个月（范围：15 - 60个月）。狼疮抗凝物的诊断依据国际血栓与止血学会的指南，包括基于凝血的检测以及抗心磷脂和抗β2糖蛋白I的酶联免疫吸附测定。
所有患者在手术前APTT延长检查后检测到狼疮抗凝物（8例腺样体切除术，1例睾丸固定术，1例眼部手术）。1例患者的抗体与传染性单核细胞增多症相关，2例在常规实验室检查中检测到。所有抗体均为原发性，53.6%的情况为短暂性。所有患者狼疮抗凝物IgG和抗β2糖蛋白I均为阴性。30.7%的患者发现因子XII:C血浆浓度略有降低（平均：38.2 UI/dl）。抗磷脂抗体诊断未伴有抗磷脂症状的临床表现，且所有患者术后均未发生出血。
原发性抗磷脂抗体在无症状儿科患者中不常见，通常与某些类型的手术（腺样体切除术、扁桃体切除术）或病毒感染相关。它们通常是短暂的且临床意义不大。这些抗体可能与因子XII血浆浓度略有降低有关，因此应考虑与轻度因子XII缺乏进行鉴别诊断。
