Hematology and Hemotherapy Center, University of Campinas, Brazil.
Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Brazil.
Thromb Res. 2018 Nov;171:114-120. doi: 10.1016/j.thromres.2018.09.058. Epub 2018 Sep 25.
The mechanisms behind the severe hypercoagulable state in antiphospholipid syndrome (APS) have not yet been fully elucidated. Knowledge on the etiology of thrombosis in APS is needed to improve treatment. We performed a case control study to evaluate the association of the levels of circulating tissue factor (TF) with thrombotic APS and unprovoked venous thromboembolism (VTE), as compared with controls without a history of thrombosis. Study participants were selected in the same geographic area. Linear regression was used to evaluate possible determinants of TF levels among controls and logistic regression was used to evaluate the association between TF, unprovoked VTE and t-APS. TF levels were grouped into three categories based on: below 50th percentile [reference], between 50-75th percentiles [second category] and 75th percentile [third category]. Two hundred and eighty participants were included in the study; 51 patients with unprovoked VTE, 111 patients with t-APS and 118 control individuals. The levels of TF were not associated with an increased risk of unprovoked VTE, as compared with controls. The adjusted odds ratio for t-APS was 2.62 (95%CI 1.03 to 6.62) with TF levels between 50-75th percentiles and 8.62 (95%CI 3.76 to 19.80) with TF levels above the 75th percentile, as compared with the reference category (below the 50th percentile). In the subgroup analysis, higher levels of TF were associated with both arterial and venous thrombosis in APS and with both primary and secondary APS. Circulating TF is associated with thrombotic complications related to APS, but not with the risk of unprovoked VTE.
抗磷脂综合征（APS）严重高凝状态的机制尚未完全阐明。为了改善治疗效果，我们需要了解 APS 中血栓形成的病因。我们进行了一项病例对照研究，以评估循环组织因子（TF）水平与血栓性 APS 和无诱因静脉血栓栓塞症（VTE）的相关性，并与无血栓形成史的对照组进行比较。研究参与者是在同一地理区域选择的。我们使用线性回归来评估对照组中 TF 水平的可能决定因素，使用逻辑回归来评估 TF、无诱因 VTE 和 t-APS 之间的关联。根据以下标准将 TF 水平分为三组：低于第 50 百分位[参考]、第 50-75 百分位[第二组]和第 75 百分位[第三组]。本研究共纳入 280 名参与者；51 名无诱因 VTE 患者、111 名 t-APS 患者和 118 名对照个体。与对照组相比，TF 水平与无诱因 VTE 的风险增加无关。TF 水平在第 50-75 百分位的 t-APS 的调整比值比为 2.62（95%CI 1.03 至 6.62），TF 水平高于第 75 百分位的 t-APS 的调整比值比为 8.62（95%CI 3.76 至 19.80），与参考组（低于第 50 百分位）相比。在亚组分析中，TF 水平升高与 APS 中的动脉和静脉血栓形成以及原发性和继发性 APS 均相关。循环 TF 与与 APS 相关的血栓并发症相关，但与无诱因 VTE 的风险无关。
