From the Service de Médecine Interne et Maladies Vasculaires, CHU, F-49000 Angers, France (G.U.).
Service de Médecine Interne, Centre National de Référence Maladies Systémiques et Auto-immunes Rares (C.M.Y., H.M., D.L., E.H., P.-Y.H., M.L.), CHU, F-59000 Lille, France.
Stroke. 2018 Nov;49(11):2770-2772. doi: 10.1161/STROKEAHA.118.023021.
Background and Purpose- International classification criteria for antiphospholipid syndrome (APS) include IgM (immunoglobulin M), aCL (anticardiolipin), and aB2GPI (anti-β2-glycoprotein-I) antibodies, but their relevance is still debated. We aimed to assess whether patients with isolated IgM aCL and/or aB2GPI at diagnosis have specific characteristics and outcomes. Methods- We retrospectively included APS patients with isolated IgM antiphospholipid antibodies (isolated-IgM-APS) and compared them to APS patients with IgG and IgM, or IgG alone and/or lupus anticoagulant (nonisolated-IgM-APS). Results- Among the 168 APS patients included, 24 (14.3%) had isolated IgM. Median follow-up was 92.5 months (36-151.5). Isolated-IgM-APS patients were 9.5 years older. At diagnosis, stroke was more frequent in isolated-IgM-APS after adjustment for cardiovascular risk factors (odds ratio, 3.8; 95% CI, 1.3-11.5). IgM isotype remained isolated in 17 of 24 (70.8%) patients over time. Global relapse-free survival did not differ between the two groups. In thrombotic APS, monotherapy with antiplatelet agents was more frequently used in isolated-IgM-APS group with 14 of 20 versus 28 of 134 patients ( P<0.0001), with a higher relapse rate with antiplatelet agent alone compared to vitamin K antagonists, especially for patients presenting with a stroke (hazard ratio, 7.37; 95% CI, 1.19-19.0). Conclusions- Isolated IgM APS patients should not be disregarded because they represent 14.3% of an APS population. They have some characteristics: older age at diagnosis and a strong association with stroke. Clinicians must be aware of this situation because antiplatelet agent do not seem to well prevent relapses compared to vitamin K antagonist.
背景与目的-国际抗磷脂综合征（APS）分类标准包括 IgM（免疫球蛋白 M）、aCL（抗心磷脂）和 aB2GPI（抗-β2-糖蛋白 I）抗体，但它们的相关性仍存在争议。我们旨在评估诊断时是否存在孤立性 IgM aCL 和/或 aB2GPI 的患者是否具有特定的特征和结局。方法-我们回顾性纳入了诊断为孤立性 IgM 抗磷脂抗体（孤立性-IgM-APS）的 APS 患者，并将其与 IgG 和 IgM 或 IgG 单独且/或狼疮抗凝剂（非孤立性-IgM-APS）的 APS 患者进行比较。结果-在纳入的 168 例 APS 患者中，有 24 例（14.3%）存在孤立性 IgM。中位随访时间为 92.5 个月（36-151.5）。孤立性-IgM-APS 患者的年龄比非孤立性-IgM-APS 患者大 9.5 岁。在调整心血管危险因素后，孤立性-IgM-APS 患者在诊断时发生中风的频率更高（优势比，3.8；95%置信区间，1.3-11.5）。24 例患者中有 17 例（70.8%）随时间推移 IgM 同种型仍保持孤立。两组间的总体无复发生存无差异。在血栓性 APS 中，与 28 例患者（14/134）相比，20 例患者（14/20）中更常单独使用抗血小板药物治疗孤立性-IgM-APS，单独使用抗血小板药物的复发率高于维生素 K 拮抗剂，尤其是对于有中风病史的患者（风险比，7.37；95%置信区间，1.19-19.0）。结论-孤立性 IgM APS 患者不应被忽视，因为他们占 APS 人群的 14.3%。他们有一些特征：诊断时年龄较大，与中风强烈相关。临床医生必须意识到这种情况，因为与维生素 K 拮抗剂相比，抗血小板药物似乎不能很好地预防复发。
