评估 IgG、IgM 和 IgA 同种型抗心磷脂抗体与 SLE 血栓形成的独立相关性。
Assessment of the independent associations of IgG, IgM and IgA isotypes of anticardiolipin with thrombosis in SLE.
机构信息
Department of Rheumatology , New York University School of Medicine , New York, New York , USA.
Department of Epidemiology and Public Health , University of Maryland, School of Medicine , Baltimore, Maryland , USA.
出版信息
Lupus Sci Med. 2016 Jun 20;3(1):e000107. doi: 10.1136/lupus-2015-000107. eCollection 2016.
OBJECTIVE
The Sydney classification criteria for antiphospholipid syndrome include lupus anticoagulant or moderate-to-high titre anticardiolipin IgG or IgM. We explored the association of all anticardiolipin isotypes, lupus anticoagulant and the combination with venous and arterial thrombosis.
METHODS
Patients with systemic lupus erythematosus (SLE) in a large clinical cohort seen quarterly were repeatedly tested by protocol for anticardiolipin antibodies and lupus anticoagulant. Subgroups of patients were defined based on the geometric mean titres of IgG, IgM, IgA anticardiolipin and lupus anticoagulant expressed in dilute Russell's viper venom time (RVVT) seconds for each patient across all cohort visits. These subgroups were compared with respect rates of thrombosis since diagnosis with SLE. Rate ratios were estimated using Cox Proportional Hazards models.
RESULTS
Of the 1390 cohort members included, there were 284 thrombotic events observed over 17 025 person-years since diagnosis for a rate of 1.7 events per 100 person-years. Those with a geometric mean titre of IgG anticardiolipin >20 had a significantly elevated rate of thromboses (rate ratio 1.8, p=0.0052), whereas there was no evidence of an association between thromboses and elevated IgM geometric mean (rate ratio 1.2, p=0.40). There were relatively few cohort members with elevated IgA geometric mean but the rate of thromboses in that group was elevated (rate ratio 1.7, p=0.23). The associations between anticardiolipin antibodies and thromboses were strongest when considering venous thromboses. Those with two or more elevated anticardiolipin isotypes or those with both IgG anticardiolipin and RVVT did not appear at higher risk than those with a single elevated marker.
CONCLUSION
This study supports previous observations that IgG anticardiolipin and lupus anticoagulant are associated with higher rates of thromboses. Our power to study IgA anticardiolipin was limited due to small number of patients with elevated IgA.
目的
抗磷脂综合征的悉尼分类标准包括狼疮抗凝物或中高滴度抗心磷脂 IgG 或 IgM。我们探讨了所有抗心磷脂同种型、狼疮抗凝物以及与静脉和动脉血栓形成的联合与静脉和动脉血栓形成的关系。
方法
在一个大型临床队列中，每季度观察系统性红斑狼疮（SLE）患者，根据方案反复检测抗心磷脂抗体和狼疮抗凝物。根据每位患者在所有队列就诊时稀释 Russell 蝰蛇毒时间（RVVT）秒表示的 IgG、IgM、IgA 抗心磷脂和狼疮抗凝物的几何均数滴度，定义患者亚组。比较这些亚组自 SLE 诊断以来的血栓形成率。使用 Cox 比例风险模型估计率比。
结果
在包括的 1390 名队列成员中，在 SLE 诊断后 17025 人年中有 284 例血栓事件发生，发生率为每 100 人年 1.7 例。那些 IgG 抗心磷脂几何均数 >20 的患者血栓形成率显著升高（率比 1.8，p=0.0052），而升高的 IgM 几何均数与血栓形成之间没有证据表明存在关联（率比 1.2，p=0.40）。具有升高 IgA 几何均数的队列成员相对较少，但该组的血栓形成率升高（率比 1.7，p=0.23）。当考虑静脉血栓形成时，抗心磷脂抗体与血栓形成之间的关联最强。那些有两种或两种以上升高的抗心磷脂同种型或有 IgG 抗心磷脂和 RVVT 的患者，与只有一种升高的标志物的患者相比，似乎没有更高的风险。
结论
本研究支持先前的观察结果，即 IgG 抗心磷脂和狼疮抗凝物与更高的血栓形成率相关。由于具有升高 IgA 的患者数量较少，我们研究 IgA 抗心磷脂的能力有限。
Zotero 插件