Meroni P L, Peyvandi F, Foco L, Bernardinelli L, Fetiveau R, Mannucci P M, Tincani A
Department of Internal Medicine, University of Milan, Milan, Italy.
J Thromb Haemost. 2007 Dec;5(12):2421-8. doi: 10.1111/j.1538-7836.2007.02763.x.
Contrasting data have been reported on the association between the presence of anti-phospholipid antibodies (aPL) and arterial thrombotic events, particularly those in coronary arteries. This discrepancy is perhaps related to the confounding effect of traditional risk factors. Among them, coronary atherosclerosis appears to be the most important in studies conducted in middle-aged and elderly patients.
To minimize such confounding effects, a multicenter case-control study on the association between aPL and myocardial infarction (MI) was carried out in a rare cohort of young premenopausal women.
We evaluated 172 cases hospitalized for a first MI before the age of 45 years and 172 controls individually matched with cases for age, sex and geographical origin. Clinical and laboratory data were collected and levels of anti-cardiolipin (aCL), anti-beta2 glycoprotein I (anti-beta2GPI) and anti-nuclear antibodies (ANA) were measured.
A significant association between MI and IgG/IgM anti-beta2GPI antibodies was observed; the results were confirmed after adjusting for smoking and hypertension (anti-beta2GPI IgG OR = 2.47, 95% CI 1.81-3.38; anti-beta2GPI IgM 4th quartile OR 3.68, 95% CI 1.69-8.02). The association between anti-beta2GPI antibodies and MI was detected in both subgroups with and without coronary artery stenosis. Whereas the association of aCL IgG with MI was modest, ANA showed no significant association with MI. No aPL were found in unselected patients (mainly males) who recently developed acute MI.
Anti-beta2GPI antibodies are a significant risk factor for MI in young premenopausal women independently of other risk factors, including the degree of coronary artery stenosis.
关于抗磷脂抗体（aPL）的存在与动脉血栓形成事件，尤其是冠状动脉血栓形成事件之间的关联，已有相互矛盾的数据报道。这种差异可能与传统危险因素的混杂效应有关。其中，在中老年患者中进行的研究显示，冠状动脉粥样硬化似乎是最重要的因素。
为尽量减少此类混杂效应，在一群罕见的绝经前年轻女性中开展了一项关于aPL与心肌梗死（MI）之间关联的多中心病例对照研究。
我们评估了172例45岁之前因首次心肌梗死住院的病例，并选取了172名在年龄、性别和地理来源方面与病例个体匹配的对照。收集了临床和实验室数据，并检测了抗心磷脂（aCL）、抗β2糖蛋白I（抗β2GPI）和抗核抗体（ANA）的水平。
观察到MI与IgG/IgM抗β2GPI抗体之间存在显著关联；在对吸烟和高血压进行校正后，结果得到证实（抗β2GPI IgG比值比[OR]=2.47，95%可信区间[CI]为1.81 - 3.38；抗β2GPI IgM第4四分位数OR为3.68，95%CI为1.69 - 8.02）。在有和没有冠状动脉狭窄的两个亚组中均检测到抗β2GPI抗体与MI之间的关联。虽然aCL IgG与MI的关联较弱，但ANA与MI未显示出显著关联。在近期发生急性心肌梗死的未经过筛选的患者（主要为男性）中未发现aPL。
抗β2GPI抗体是绝经前年轻女性发生MI的一个重要危险因素，独立于其他危险因素，包括冠状动脉狭窄程度。
