Critical Care, St Michael's Hospital, Toronto, Ontario, Canada.
Departments of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.
Ann Rheum Dis. 2021 Sep;80(9):1236-1240. doi: 10.1136/annrheumdis-2021-220206. Epub 2021 Apr 26.
Reports of severe COVID-19 being associated with thrombosis, antiphospholipid antibodies (APLA), and antiphospholipid syndrome have yielded disparate conclusions. Studies comparing patients with COVID-19 with contemporaneous controls of similar severity are lacking.
22 COVID-19 and 20 COVID-19 patients with respiratory failure admitted to intensive care were studied longitudinally. Demographic and clinical data were obtained from the day of admission. APLA testing included anticardiolipin (aCL), anti-β2glycoprotien 1 (β2GP1), antidomain 1 β2GP1 and antiphosphatidyl serine/prothrombin complex. Antinuclear antibodies (ANAs) were detected by immunofluorescence and antibodies to cytokines by a commercially available multiplexed array. Analysis of variance was used for continuous variables and Fisher's exact test was used for categorical variables with α=0.05 and the false discovery rate at q=0.05.
APLAs were predominantly IgG aCL (48%), followed by IgM (21%) in all patients, with a tendency towards higher frequency among the COVID-19. aCL was not associated with surrogate markers of thrombosis but IgG aCL was strongly associated with worse disease severity and higher ANA titres regardless of COVID-19 status. An association between aCL and anticytokine autoantibodies tended to be higher among the COVID-19.
Positive APLA serology was associated with more severe disease regardless of COVID-19 status.
NCT04747782.
有报道称，严重的 COVID-19 与血栓形成、抗磷脂抗体 (APLA) 和抗磷脂综合征有关，但得出的结论却大相径庭。目前缺乏将 COVID-19 患者与具有相似严重程度的同期对照患者进行比较的研究。
对 22 名因 COVID-19 而入住重症监护病房的 COVID-19 患者和 20 名因 COVID-19 而出现呼吸衰竭的 COVID-19 患者进行了纵向研究。从入院当天开始收集人口统计学和临床数据。APLA 检测包括抗心磷脂 (aCL)、抗-β2糖蛋白 1 (β2GP1)、抗域 1 β2GP1 和抗磷脂酰丝氨酸/凝血酶原复合物。通过免疫荧光法检测抗核抗体 (ANA)，并通过商业上可用的多重阵列检测细胞因子抗体。连续变量采用方差分析，分类变量采用 Fisher 精确检验，α=0.05，假发现率 q=0.05。
所有患者的 APLA 主要为 IgG aCL（48%），其次为 IgM（21%），且 COVID-19 患者的 APLA 频率较高。aCL 与血栓形成的替代标志物无关，但 IgG aCL 与疾病严重程度更高和 ANA 滴度更高相关，与 COVID-19 状态无关。无论 COVID-19 状态如何，aCL 与抗细胞因子自身抗体之间的关联趋势更高。
无论 COVID-19 状态如何，APLA 血清学阳性与疾病更严重相关。
NCT04747782。
