Zuo Yu, Fan Jennifer, Sarode Ravi, Zhang Song, Makris Una E, Karp David R, Shen Yu-Min
1 University of Texas Southwestern Medical Center, Dallas, TX, USA.
2 VA North Texas Health Care System, Dallas, TX, USA.
Clin Appl Thromb Hemost. 2018 Sep;24(6):980-985. doi: 10.1177/1076029618755946. Epub 2018 Feb 22.
The evaluation of thrombotic and pregnancy risks associated with antiphospholipid antibodies (aPL)in individual patients without antiphospholipid syndrome (APS) clinical manifestation is challenging. Our aim is to identify additional risk factors or potential candidate "second hits" for APS clinical events in a large cohort of ethnically diverse aPL-positive patients. We included 219 consecutive aPL-positive patients who attended clinic at our institution. All patients had at least 1 persistent high titer (≥99 percentiles) aPL. Independent risk factors for thrombosis and pregnancy morbidities among patients with positive aPL were evaluated. When assessing risk factors associated with pregnancy morbidities, only female controls of reproductive age (age ≤45) were used. Pearson χ analysis and multivariable logistic regression were used to evaluate correlation between different risk factors and clinical manifestations. Of the 219 aPL-positive patients, 120 (54.8%) patients had criteria APS clinical manifestations and 99 patients did not. A total of 46.1% were Caucasian, 26.4% of African descent, 16.9% Hispanic, 1.8% Asian, and 8.7% were unspecified. Among traditional risk factors and signs of endothelial injury, only hypertension demonstrated an independent association with arterial thrombosis (odds ratio [OR] = 3.826, 95% confidence interval [CI]: 1.597-9.167, P = .0026), and lupus anticoagulant (LA) demonstrated an independent association with venous thrombosis (OR = 3.308, 95% CI: 1.544-7.085, P = .0021). None of the evaluated risk factors demonstrated a significant association with pregnancy morbidity. Hypertension is a potential predictor of arterial thrombosis and the presence of LA is a potential predictor of venous thrombosis in aPL-positive patients.
在无抗磷脂综合征（APS）临床表现的个体患者中，评估与抗磷脂抗体（aPL）相关的血栓形成和妊娠风险具有挑战性。我们的目标是在一大群种族多样的aPL阳性患者中，识别出APS临床事件的其他风险因素或潜在的候选“二次打击”因素。我们纳入了在我们机构门诊就诊的219例连续的aPL阳性患者。所有患者至少有1种持续的高滴度（≥99百分位数）aPL。评估了aPL阳性患者中血栓形成和妊娠并发症的独立风险因素。在评估与妊娠并发症相关的风险因素时，仅使用育龄期女性对照（年龄≤45岁）。采用Pearson χ分析和多变量逻辑回归来评估不同风险因素与临床表现之间的相关性。在219例aPL阳性患者中，120例（54.8%）患者有APS的标准临床表现，99例患者没有。共有46.1%为白种人，26.4%为非洲裔，16.9%为西班牙裔，1.8%为亚洲裔，8.7%未明确种族。在传统风险因素和内皮损伤迹象中，只有高血压与动脉血栓形成存在独立关联（比值比[OR]=3.826，95%置信区间[CI]：1.597 - 9.167，P = 0.0026），狼疮抗凝物（LA）与静脉血栓形成存在独立关联（OR = 3.308，95% CI：1.544 - 7.085，P = 0.0021）。所评估的风险因素均未显示与妊娠并发症有显著关联。高血压是aPL阳性患者动脉血栓形成的潜在预测因素，LA的存在是静脉血栓形成的潜在预测因素。
