Pengo Vittorio, Testa Sophie, Martinelli Ida, Ghirarduzzi Angelo, Legnani Cristina, Gresele Paolo, Passamonti Serena M, Bison Elisa, Denas Gentian, Jose Seena Padayattil, Banzato Alessandra, Ruffatti Amelia
Clinical Cardiology, University Hospital, Padova, Italy.
Laboratory Medicine, District Hospital, Cremona, Italy.
Thromb Res. 2015 Jan;135(1):46-9. doi: 10.1016/j.thromres.2014.10.013. Epub 2014 Oct 22.
Among the so called antiphospholipid (aPL) antibodies Lupus Anticoagulant (LAC) is considered the strongest risk factor for thromboembolic events. In individuals without a previous thromboembolic event (carriers), LAC is a risk factor when associated with the presence of anticardiolipin (aCL) and aβ2-Glycoprotein I (aβ2GPI) antibodies. On the other hand, data on carriers of isolated LAC positivity are sparse and inconclusive. The aim of this study was to prospectively determine the incidence of thrombosis in a cohort of carriers of isolated LAC positivity. One-hundred seventy-nine carriers of LAC confirmed twelve weeks apart and in a reference laboratory were studied. During a total follow up of 552 person-years, there were seven thromboembolic events (1.3% person-y). All the seven patients had at least one adjunctive major risk factor for thrombosis. The cumulative incidence of thromboembolic events was 3.1% (95% CI 0.6-5.6) after 2years, and 5.9% (95% CI 1.2-10.6) after 5 and 10years. On a multivariate regression analysis considering age, sex, autoimmune disease, risk factors for arterial and venous thrombosis, use of aspirin, only age was found to be an independent predictor of thromboembolic events (HR=1.1, 95% CI 1.0-1.2, p=0.02). These data might be relevant in clinical practice and underline the importance of differentiating LAC carriers in terms of isolated positivity or positivity associated with the presence of antibodies to aCL and β2-glycoprotein I.
在所谓的抗磷脂（aPL）抗体中，狼疮抗凝物（LAC）被认为是血栓栓塞事件的最强危险因素。在既往无血栓栓塞事件的个体（携带者）中，LAC与抗心磷脂（aCL）和抗β2-糖蛋白I（aβ2GPI）抗体同时存在时是一个危险因素。另一方面，关于单纯LAC阳性携带者的数据稀少且尚无定论。本研究的目的是前瞻性地确定单纯LAC阳性携带者队列中血栓形成的发生率。对179名经参考实验室确诊且间隔12周的LAC携带者进行了研究。在总共552人年的随访期间，发生了7例血栓栓塞事件（1.3%人年）。所有7例患者至少有一项血栓形成的辅助主要危险因素。2年后血栓栓塞事件的累积发生率为3.1%（95%CI 0.6-5.6），5年和10年后为5.9%（95%CI 1.2-10.6）。在考虑年龄、性别、自身免疫性疾病、动脉和静脉血栓形成的危险因素、阿司匹林使用情况的多变量回归分析中，仅发现年龄是血栓栓塞事件的独立预测因素（HR=1.1，95%CI 1.0-1.2，p=0.02）。这些数据可能在临床实践中具有相关性，并强调了区分单纯LAC阳性携带者与同时存在aCL和β2-糖蛋白I抗体阳性携带者的重要性。
