Somers Emily, Magder Laurence S, Petri Michelle
Johns Hopkins University, School of Medicine, Baltimore, MD 21205, USA.
J Rheumatol. 2002 Dec;29(12):2531-6.
To study the relationship between antiphospholipid antibodies (aPL) and the incidence of venous thrombosis (VT) among patients with systemic lupus erythematosus (SLE).
The study population consisted of 678 patients with SLE enrolled in the Hopkins Lupus Cohort. Medical records were reviewed to identify the occurrence of VT prior to cohort entry. During cohort participation, VT was diagnosed by ultrasound or venography. Lupus anticoagulant [LAC, Russell viper venom time (RVVT) assay] and anticardiolipin (aCL, polyclonal assay) status of each subject was determined on a quarterly basis. The Kaplan-Meier approach was used to estimate probability of having a VT over time since SLE diagnosis. The association between the most recently measured values of LAC and aCL on the subsequent risk of VT was estimated using Cox proportional hazards models.
Counting only first occurrences, the rate of VT was 5.1 cases per 1000 person-years. Of those with a mean RVVT greater than 37 s during followup, an estimated 42% will develop a VT within 20 years of SLE diagnosis [95% confidence interval (CI) 21% to 63%, p < 0.0001 compared to those with lower RVVT]. The immediate risk (hazard) of deep venous thrombosis increased 34% with each 5 second prolongation of the RVVT test, based on the most recent assessment of RVVT, controlling for gender and cholesterol [p = 0.0022, 95% CI 11% to 61%]. Of those with a mean polyclonal aCL greater than 2.3 units, 34% developed a VT within 20 years of SLE diagnosis (95% CI 11% to 57%, p = 0.0097 compared to those with lower aCL). The immediate risk (hazard) of deep venous thrombosis was not significantly associated with the most recent assessment of aCL.
This large prospective study indicates that patients with SLE are at substantial risk for VT over time. Both the presence of a LAC and of polyclonal aCL are associated with the risk of VT, but LAC is a better predictor of risk than is aCL.
研究抗磷脂抗体（aPL）与系统性红斑狼疮（SLE）患者静脉血栓形成（VT）发生率之间的关系。
研究人群包括霍普金斯狼疮队列中纳入的678例SLE患者。回顾病历以确定队列入组前VT的发生情况。在队列研究期间，通过超声或静脉造影诊断VT。每季度测定每位受试者的狼疮抗凝物[LAC，蝰蛇毒时间（RVVT）检测]和抗心磷脂（aCL，多克隆检测）状态。采用Kaplan-Meier方法估计自SLE诊断以来随时间发生VT的概率。使用Cox比例风险模型估计LAC和aCL的最新测量值与随后VT风险之间的关联。
仅计算首次发生情况，VT发生率为每1000人年5.1例。在随访期间平均RVVT大于37秒的患者中，估计42%将在SLE诊断后20年内发生VT[95%置信区间（CI）21%至63%，与RVVT较低者相比，p<0.0001]。根据RVVT的最新评估，在控制性别和胆固醇的情况下，RVVT检测每延长5秒，深静脉血栓形成的即时风险（风险）增加34%[p = 0.0022，95% CI 11%至61%]。在平均多克隆aCL大于2.3单位的患者中，34%在SLE诊断后20年内发生VT（95% CI 11%至57%，与aCL较低者相比，p = 0.0097）。深静脉血栓形成的即时风险（风险）与aCL的最新评估无显著关联。
这项大型前瞻性研究表明，SLE患者长期存在发生VT的重大风险。LAC和多克隆aCL的存在均与VT风险相关，但LAC比aCL更能预测风险。
