Servicio de Reumatología, Hospital General San Martin La Plata, Buenos Aires, Argentina.
Sección de Reumatología, Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina.
Lupus. 2020 Dec;29(14):1866-1872. doi: 10.1177/0961203320960814. Epub 2020 Oct 7.
Assessment of risk both for pregnancy morbidity and thrombosis in the presence of anti-phospholipid antibodies (aPL) is still a challenge in Systemic Lupus Erythematosus (SLE) patients. The Global Antiphospholipid Syndrome Score (GAPSS) takes into account the aPL profile (criteria and non-criteria aPL), the conventional cardiovascular risk factors and the autoimmune antibody profile. An adjusted model of the score (aGAPSS) excluding anti-phosphatidylserine/Prothrombin (aPS/PT), suggests that the score is able to stratify patients for their rate of events making it widely applicable in daily clinical practice.
To validate the aGAPSS in a multicentric cohort of SLE patients in Argentina.
consecutive SLE patients with and with andwithout thrombotic events from seven Rheumatologist centers were included. Traditional cardiovascular risk factors, aPL antibodies and medications received (aspirin, hydroxychloroquine and anticoagulation) were collected. The score aGAPSS was calculated for each patient at the last visit by adding together the points corresponding to the risk factors: 1 for hypertension, 3 for dyslipidemia, 4 for LA and B2GPI (IgM or IgG) antibodies and 5 for aCL (IgM or IgG) antibodies. The discriminative ability of the aGAPSS was calculated by measuring the area under the receiver operating characteristic curve (AUC). Multivariate logistic regression analysis was performed to examine the impact of multiple cardiovascular risk factors and laboratory parameters on the occurrence of thrombosis.
Two hundred and ninety-six SLE patients were included. One-hundred and twenty-one patients (40.9%) presented thrombotic and/or pregnancy complications. Median aGAPSS was significantly higher in patients who experienced an event (thrombosis and/or pregnancy morbidity) compared with those without [4 (IQR 1-9) versus 1 (IQR 0-5); p < 0.001]. The best cut off point for the diagnosis of thrombosis and/or pregnancy complications was aGAPSS ≥4. Multivariate logistic regression analysis showed that aCL antibodies [OR 2.1 (95% CI 1.16-3.90); p = 0.015] were an independent risk factors for thrombotic events.
This score is a simple tool, easy to apply to SLE patients in daily practice. The use of the aGAPSS could change the non-pharmacologic and pharmacologic treatment in higher risk patients to improve their survival.
在抗磷脂抗体（aPL）阳性的系统性红斑狼疮（SLE）患者中，评估妊娠并发症和血栓形成风险仍然具有挑战性。全球抗磷脂综合征评分（GAPSS）考虑了 aPL 谱（标准和非标准 aPL）、传统心血管危险因素和自身抗体谱。排除抗磷脂酰丝氨酸/凝血酶原（aPS/PT）后的评分调整模型（aGAPSS）表明，该评分能够对患者进行分层，以评估其发生事件的风险，使其在日常临床实践中广泛适用。
在阿根廷的多中心 SLE 患者队列中验证 aGAPSS。
纳入了来自七个风湿病中心的有和无血栓事件的连续 SLE 患者。收集了传统心血管危险因素、aPL 抗体和接受的药物（阿司匹林、羟氯喹和抗凝剂）。通过将相应危险因素的分数相加，为每位患者计算最后一次就诊时的 aGAPSS 评分：高血压加 1 分，血脂异常加 3 分，狼疮抗凝物和抗β2糖蛋白 I（IgM 或 IgG）抗体加 4 分，抗心磷脂（IgM 或 IgG）抗体加 5 分。通过测量受试者工作特征曲线下面积（AUC）来计算 aGAPSS 的判别能力。进行多变量逻辑回归分析，以检查多种心血管危险因素和实验室参数对血栓形成发生的影响。
共纳入 296 例 SLE 患者。121 例（40.9%）患者发生血栓形成和/或妊娠并发症。与无事件（血栓形成和/或妊娠并发症）患者相比，发生事件患者的中位 aGAPSS 显著升高[4（IQR 1-9）比 1（IQR 0-5）；p<0.001]。aGAPSS≥4 是诊断血栓形成和/或妊娠并发症的最佳截断值。多变量逻辑回归分析显示，抗心磷脂抗体[比值比 2.1（95%可信区间 1.16-3.90）；p=0.015]是血栓形成事件的独立危险因素。
该评分是一种简单的工具，易于在 SLE 患者的日常实践中应用。使用 aGAPSS 可以改变高危患者的非药物和药物治疗，以提高他们的生存率。
