Forastiero R, Martinuzzo M, Pombo G, Puente D, Rossi A, Celebrin L, Bonaccorso S, Aversa L
Division of Hematology, Thrombosis and Hemostasis, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation, Favaloro University, Buenos Aires, Argentina.
J Thromb Haemost. 2005 Jun;3(6):1231-8. doi: 10.1111/j.1538-7836.2005.01295.x.
Antiphospholipid syndrome (APS) is a clinical autoimmune disorder characterized by thrombosis/pregnancy morbidity associated with the persistence of lupus anticoagulant (LA) and/or anticardiolipin (aCL) antibodies. We assessed the contribution of antibodies to beta2-glycoprotein I (anti-beta2GPI) and prothrombin (anti-PT) to the thrombotic risk in a cohort of 194 consecutive patients with persistent LA and/or aCL. Median follow-up was 45 months. A total of 39 patients (20.1%) had one documented episode of thrombosis during follow-up. Eleven of these patients had no previous thrombosis before enrollment in the study and 28 had recurrences of thrombosis. There were 21 venous and 18 arterial thrombotic events and the overall incidence of thrombosis was 5.6% per patient-year. After multivariate analysis, the male sex (P = 0.025), a previous thrombosis (P < 0.01), the presence of anti-beta2GPI (P = 0.001), and the presence of anti-PT (P = 0.03) remained as independent risk factors for recurrent thrombosis. Only IgG anti-beta2GPI and anti-PT were associated with an increased risk of thrombosis (P < 0.01 and P = 0.005). Patients testing positive for anti-beta2GPI had a higher rate of thrombosis than did antiphospholipid patients without anti-beta2GPI (8.0% vs. 3.1% per patient-year). Similarly, a higher rate of thrombosis was found in patients with positive anti-PT compared with patients without anti-PT (8.6% vs. 3.5% per patient-year). Considering only the group of 142 LA positive patients, the highest incidence of thrombosis was found in LA patients positive for both anti-beta2GPI and anti-PT (8.4% per patient-year). In conclusion, the presence of IgG anti-beta2GPI and anti-PT in patients with LA and/or aCL and mainly in those with LA predicts a higher risk of thromboembolic events.
抗磷脂综合征（APS）是一种临床自身免疫性疾病，其特征为与狼疮抗凝物（LA）和/或抗心磷脂（aCL）抗体持续存在相关的血栓形成/妊娠并发症。我们评估了194例连续的LA和/或aCL持续阳性患者队列中，抗β2糖蛋白I抗体（抗β2GPI）和抗凝血酶原抗体（抗PT）对血栓形成风险的影响。中位随访时间为45个月。共有39例患者（20.1%）在随访期间发生了1次有记录的血栓形成事件。其中11例患者在纳入研究前无血栓形成史，28例患者发生了血栓复发。有21例静脉血栓事件和18例动脉血栓事件，血栓形成的总体发生率为每年每例患者5.6%。多因素分析后，男性（P = 0.025）、既往有血栓形成史（P < 0.01）、存在抗β2GPI（P = 0.001）和存在抗PT（P = 0.03）仍然是复发性血栓形成的独立危险因素。只有IgG抗β2GPI和抗PT与血栓形成风险增加相关（P < 0.01和P = 0.005）。抗β2GPI检测呈阳性的患者血栓形成发生率高于无抗β2GPI的抗磷脂患者（每年每例患者8.0%对3.1%）。同样，抗PT阳性患者的血栓形成发生率高于无抗PT的患者（每年每例患者8.6%对3.5%）。仅考虑142例LA阳性患者组，抗β2GPI和抗PT均阳性的LA患者血栓形成发生率最高（每年每例患者8.4%）。总之，LA和/或aCL患者，主要是LA患者中存在IgG抗β2GPI和抗PT预示着更高的血栓栓塞事件风险。
