Wielosz Ewa, Majdan Maria, Koszarny Arkadiusz, Dryglewska Magdalena, Tabarkiewicz Jacek
Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland.
Centre for Innovative Research in Medical and Natural Sciences, Medical Faculty of University of Rzeszow, Rzeszow, Poland.
Cent Eur J Immunol. 2017;42(2):161-166. doi: 10.5114/ceji.2017.69358. Epub 2017 Aug 8.
The aim of the study was the assessment of changes in the glomerular filtration rate (GFR) during long-term observation in a group of systemic sclerosis (SSc) patients with and without chronic antiphospholipid (aPL) antibody positivity.
The observation comprised 50 patients - 23 with diffuse cutaneous SSc - dcSSc and 27 limited cutaneous SSc - lcSSc. After 24 months we assessed 27 patients (9 died, 14 lost follow up); 24 patients (88%) were treated chronically with angiotensin-converting-enzyme inhibitors (ACEIs). Patients were investigated for the presence of aPL: to cardiolipin and to β2 glycoprotein I in IgM and IgG classes. Serum levels of creatinine (S-Cr), cystatin C and creatinine clearance values were determined in all patients. According to the presence of a significant level of at least one of aPL antibodies, pts were divided into groups: group I aPL positive: 14 patients, group II aPL negative - 13 patients.
We did not find significant differences in S-Cr, cystatin C levels and creatinine clearance before and after 24 months of observation between both groups. In follow up observations, the presence of anti-centromere antibodies was significantly more frequent in the aPL positive, as compared to the aPL negative group (p = 0.01). In follow up observations, the level of anticardiolipin antibodies in IgG class was significantly higher in dcSSc compared to lcSSc patients (p = 0.02).
In long-term observation chronic positivity for aPL antibodies does not significantly decrease the GFR in patients with SSc treated with ACEIs.
本研究旨在评估一组系统性硬化症（SSc）患者在长期观察期间，无论有无慢性抗磷脂（aPL）抗体阳性，其肾小球滤过率（GFR）的变化情况。
观察对象为50例患者，其中23例为弥漫性皮肤型SSc（dcSSc），27例为局限性皮肤型SSc（lcSSc）。24个月后，我们对27例患者进行了评估（9例死亡，14例失访）；24例患者（88%）长期接受血管紧张素转换酶抑制剂（ACEIs）治疗。对患者进行aPL检测：检测IgM和IgG类抗心磷脂抗体及抗β2糖蛋白I抗体。测定所有患者的血清肌酐（S-Cr）、胱抑素C水平及肌酐清除率值。根据至少一种aPL抗体是否存在显著水平，将患者分为两组：I组aPL阳性：14例患者，II组aPL阴性：13例患者。
两组患者在观察24个月前后的S-Cr、胱抑素C水平及肌酐清除率方面未发现显著差异。在随访观察中，与aPL阴性组相比，aPL阳性组抗着丝点抗体的出现频率显著更高（p = 0.01）。在随访观察中，dcSSc患者IgG类抗心磷脂抗体水平显著高于lcSSc患者（p = 0.02）。
在长期观察中，aPL抗体慢性阳性并不会显著降低接受ACEIs治疗的SSc患者的GFR。
