Department of Haematology, University Hospital, Nîmes and University of Montpellier, France.
Thromb Res. 2013 Jan;131 Suppl 1:S28-31. doi: 10.1016/S0049-3848(13)70016-1.
The antiphospholipid syndrome (APS) is characterised by thrombotic or obstetric symptoms associated with persistent antiphospholipid antibodies (aPL). Despite an increasing standardisation of aPLs testing, which is prone to strong evolutions due to brilliant progresses in the understanding of APS pathophysiology, the specificity and sensitivity of the epidemiological associations between symptoms and aPLs are highly variable, with persistent strong equivocal evidences probably leading to over-diagnosis, particularly in the obstetrical presentations where consistent association studies are rare and levels of evidence limited. We propose to review the APS definition based on biological mechanisms, to abandon the clinical syndromes which are still molecularly unclassified like "unexplained recurrent pregnancy losses before week 10" and the aspecific markers like classic anticardiolipin antibodies, and finally to narrow APS criteria asa constructive promise for a determined move toward precision medicine.
抗磷脂综合征 (APS) 的特征是存在与持续抗磷脂抗体 (aPL) 相关的血栓或产科症状。尽管 aPL 检测的标准化程度不断提高，但由于对 APS 病理生理学的理解取得了显著进展，因此很容易发生变化，但症状与 aPL 之间的流行病学关联的特异性和敏感性差异很大，持续存在的强烈不确定性证据可能导致过度诊断，特别是在产科表现中，这种关联研究很少，证据水平有限。我们建议根据生物学机制重新审查 APS 的定义，摒弃那些仍未分子分类的临床综合征，如“10 周前不明原因的反复妊娠丢失”和非特异性标志物，如经典抗心磷脂抗体，并最终缩小 APS 标准范围，为向精准医学迈进提供一个有建设性的承诺。
