抗磷脂综合征修订分类标准及自身免疫性疾病患者的血栓形成风险

Revised classification criteria for antiphospholipid syndrome and the thrombotic risk in patients with autoimmune diseases.

作者信息

Swadźba J, Iwaniec T, Szczeklik A, Musiał J

机构信息

Department of Medicine, Jagiellonian University School of Medicine, Kraków, Poland.

出版信息

J Thromb Haemost. 2007 Sep;5(9):1883-9. doi: 10.1111/j.1538-7836.2007.02669.x. Epub 2007 Jun 26.

DOI:10.1111/j.1538-7836.2007.02669.x

PMID:17596131

Abstract

BACKGROUND

The classification criteria for antiphospholipid syndrome (APS) were updated in 2006.

OBJECTIVE

The aim of the study was to analyze associations between clinical complications and laboratory test abnormalities typical for APS in a group of patients with autoimmune diseases, based on the recently updated criteria.

PATIENTS/METHODS: Three hundred and thirty-six patients were enrolled into the study, with the majority (n = 235) suffering from systemic lupus erythematosus. Laboratory determinations included: lupus anticoagulant (LA), anticardiolipin (aCL) and anti-beta(2)-glycoprotein I (anti-beta(2)GPI) antibodies (ABs) [of both immunoglobulin G (IgG) and IgM class].

RESULTS

A significant association was found between laboratory and clinical features of APS; odds ratios (ORs) for thrombosis associated with the presence of LA, aCL, and anti-beta(2)GPI Abs were 4.04 [95% CI: 2.44-6.68], 3.71 (95% CI 2.32-5.92) and 2.57 (95% CI 1.60-4.1), respectively. Detailed analysis showed marked differences between the risk of clinical complications associated with the presence of an antibody in the IgG class (OR 4.15, 95% CI 2.42-7.12, and OR 4.77, 95% CI 2.37-9.61 for aCL and anti-beta(2)GPI, respectively) and in the IgM class (OR 2.2, 95% CI 1.31-3.70, and OR 1.9, 95% CI 1.15-3.14 for aCL and anti-beta(2)GPI, respectively). The postulated inclusion of anti-beta(2)GPI antibody positivity into the previous laboratory criteria changed only slightly the number of patients diagnosed with APS (from 112 to 117).

CONCLUSIONS

The updated APS classification criteria clearly represent a step forward. However, our results argue against the use of overall positivity for aCL or anti-beta(2)GPI, and favor a clear distinction between the IgG and IgM classes of antiphospholipid ABs. Patients with both LA and anti-beta(2)GPI IgG or LA and aCL IgG positivity may represent the subgroups at the highest risk of thrombotic complications.

摘要

背景

抗磷脂综合征（APS）的分类标准于2006年更新。

目的

本研究旨在基于最近更新的标准，分析一组自身免疫性疾病患者中临床并发症与APS典型实验室检查异常之间的关联。

患者/方法：336例患者纳入研究，其中大多数（n = 235）患有系统性红斑狼疮。实验室检测包括：狼疮抗凝物（LA）、抗心磷脂（aCL）和抗β2糖蛋白I（抗β2GPI）抗体（ABs）[免疫球蛋白G（IgG）和IgM类]。

结果

发现APS的实验室检查特征与临床特征之间存在显著关联；与LA、aCL和抗β2GPI抗体存在相关的血栓形成优势比（OR）分别为4.04 [95%可信区间（CI）：2.44 - 6.68]、3.71（95% CI 2.32 - 5.92）和2.57（95% CI 1.60 - 4.1）。详细分析显示，与IgG类抗体存在相关的临床并发症风险（aCL和抗β2GPI的OR分别为4.15，95% CI 2.42 - 7.12和OR 4.77，95% CI 2.37 - 9.61）与IgM类抗体存在相关的临床并发症风险（aCL和抗β2GPI的OR分别为2.2，95% CI 1.31 - 3.70和OR 1.9，95% CI 1.15 - 3.14）之间存在明显差异。将抗β2GPI抗体阳性纳入先前的实验室标准后，诊断为APS的患者数量仅略有变化（从112例增至117例）。