Taraborelli M, Lazzaroni M G, Martinazzi N, Fredi M, Cavazzana I, Franceschini F, Tincani A
Rheumatology and Clinical Immunology, Spedali Civili of Brescia.
Reumatismo. 2016 Dec 16;68(3):137-143. doi: 10.4081/reumatismo.2016.891.
The objective is to investigate the role of clinically significant antiphospholipid antibodies (aPL) in a cohort of systemic lupus erythematosus (SLE) patients. All SLE patients followed for at least 5 years and with available aPL profile at the beginning of the follow-up in our center were studied. Clinically significant aPL were defined as: positive lupus anticoagulant test, anti-cardiolipin and/or anti- β2Glycoprotein I IgG/IgM >99th percentile on two or more occasions at least 12 weeks apart. Patients with and without clinically significant aPL were compared by univariate (Chi square or Fisher's exact test for categorical variables and Student's t or Mann-Whitney test for continuous variables) and multivariate analysis (logistic regression analysis). P values <0.05 were considered significant. Among 317 SLE patients studied, 117 (37%) had a clinically significant aPL profile at baseline. Such patients showed at univariate analysis an increased prevalence of deep venous thrombosis, pulmonary embolism, cardiac valvular disease, cognitive dysfunction and antiphospholipid syndrome (APS), but a reduced prevalence of acute cutaneous lupus and anti-extractable nuclear antigens (ENA) when compared with patients without clinically significant aPL. Multivariate analysis confirmed the association between clinically significant aPL and reduced risk of acute cutaneous lupus [p=0.003, odds ratio (OR) 0.43] and ENA positivity (p<0.001, OR 0.37), with increased risk of cardiac valvular disease (p=0.024, OR 3.1) and APS (p<0.0001, OR 51.12). Triple positivity was the most frequent profile and was significantly associated to APS (p<0.0001, OR 28.43). Our study showed that one third of SLE patients had clinically significant aPL, and that this is associated with an increased risk, especially for triple positive, of APS, and to a different clinical and serological pattern of disease even in the absence of APS.
目的是研究具有临床意义的抗磷脂抗体（aPL）在一组系统性红斑狼疮（SLE）患者中的作用。对在本中心随访至少5年且随访开始时具有可用aPL谱的所有SLE患者进行了研究。具有临床意义的aPL定义为：狼疮抗凝物试验阳性、抗心磷脂和/或抗β2糖蛋白I IgG/IgM在至少相隔12周的两次或更多次检测中高于第99百分位数。对有和没有具有临床意义的aPL的患者进行单因素分析（分类变量采用卡方检验或Fisher精确检验，连续变量采用Student t检验或Mann-Whitney检验）和多因素分析（逻辑回归分析）。P值<0.05被认为具有统计学意义。在研究的317例SLE患者中，117例（37%）在基线时具有具有临床意义的aPL谱。单因素分析显示，与没有具有临床意义的aPL的患者相比，此类患者深静脉血栓形成、肺栓塞、心脏瓣膜病、认知功能障碍和抗磷脂综合征（APS）的患病率增加，但急性皮肤型狼疮和抗可提取核抗原（ENA）的患病率降低。多因素分析证实，具有临床意义的aPL与急性皮肤型狼疮风险降低[p=0.003，比值比（OR）0.43]和ENA阳性（p<0.001，OR 0.37）相关，同时心脏瓣膜病（p=0.024，OR 3.1）和APS（p<0.0001，OR 51.12）风险增加。三联阳性是最常见的谱型，且与APS显著相关（p<0.0001，OR 28.43）。我们的研究表明，三分之一的SLE患者具有具有临床意义的aPL，这与APS风险增加相关，尤其是三联阳性患者，并且即使在没有APS的情况下，也与不同的临床和血清学疾病模式相关。
