Calcaterra Ilenia, Ambrosino Pasquale, Vitelli Nicoletta, Lupoli Roberta, Orsini Roberta Clara, Chiurazzi Martina, Maniscalco Mauro, Di Minno Matteo Nicola Dario
Department of Clinical Medicine and Surgery, Faculty of Medicine and Surgery, Federico II University, 80131 Naples, Italy.
Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy.
Biomedicines. 2021 Jan 27;9(2):122. doi: 10.3390/biomedicines9020122.
Antiphospholipid antibodies (aPL) are a cluster of autoantibodies directed against plasma proteins with affinity for membrane phospholipids. The most frequently tested aPL are lupus anticoagulant (LA), anti-cardiolipin antibodies (aCL), and anti-β2-glycoprotein I antibodies (anti-β2GPI). aPL play a key pathogenic role in the development of the antiphospholipid syndrome (APS), a systemic autoimmune disease characterized by recurrent thrombotic and/or pregnancy complications in patients with persistent aPL. However, aPL positivity is occasionally documented in patients with no previous history of thrombotic or pregnancy morbidity. LA activity, multiple aPL positivity, high-titer aPL, and a concomitant systemic autoimmune disease are recognized risk factors for future thrombotic events in asymptomatic carriers. Moreover, an accelerated atherosclerosis with increased cardiovascular (CV) risk has also been associated with aPL positivity, thus exposing aPL carriers to fatal complications and chronic disability requiring cardiac rehabilitation. Overall, an accurate risk stratification is recommended for aPL-positive subjects in order to prevent both venous and arterial thrombotic complications. In this review, we provide an overview of the main antithrombotic and risk assessment strategies in aPL carriers.
抗磷脂抗体（aPL）是一类针对与膜磷脂具有亲和力的血浆蛋白的自身抗体。最常检测的aPL是狼疮抗凝物（LA）、抗心磷脂抗体（aCL）和抗β2糖蛋白I抗体（抗β2GPI）。aPL在抗磷脂综合征（APS）的发生发展中起关键致病作用，APS是一种系统性自身免疫性疾病，其特征是持续存在aPL的患者反复出现血栓形成和/或妊娠并发症。然而，既往无血栓形成或妊娠相关疾病史的患者偶尔也会出现aPL阳性。LA活性、多种aPL阳性、高滴度aPL以及合并系统性自身免疫性疾病是无症状携带者未来发生血栓事件的公认危险因素。此外，aPL阳性还与动脉粥样硬化加速及心血管（CV）风险增加有关，从而使aPL携带者面临致命并发症和需要心脏康复的慢性残疾风险。总体而言，建议对aPL阳性患者进行准确的风险分层，以预防静脉和动脉血栓并发症。在本综述中，我们概述了aPL携带者主要的抗血栓形成和风险评估策略。
