Billoir Paul, Miranda Sébastien, Levesque Herve, Benhamou Ygal, Le Cam Duchez Véronique
Vascular Hemostasis Unit, Rouen University Hospital, Normandie University, UNIROUEN, INSERM U1096, F 76000 Rouen, France.
Vascular and Thrombosis Unit, Department of Internal Medicine, Rouen University Hospital, Normandie University, UNIROUEN, INSERM U1096, F 76000 Rouen, France.
J Clin Med. 2021 Jun 21;10(12):2728. doi: 10.3390/jcm10122728.
Antiphospholipid syndrome (APS) is associated with thrombotic events (tAPS) and/or obstetrical morbidity (oAPS), with persisting antiphospholipid antibodies (aPL). Despite an update of aPL in 2006, several patients had typical clinical events without the classical biological criteria. The aim of our study was to evaluate the hypercoagulability state with both thrombin generation (TG) profiles and activated protein C resistance (aPCR) in different types of APS.
We retrospectively included 41 patients with Sydney criteria classification (tAPS, oAPS) and no clinical manifestation of APS with persistent aPL (biological APS). A thrombin generation assay was performed with a Fluoroskan Ascent fluorometer in platelet-poor plasma (PPP). Activated protein C resistance was measured as a ratio: ETP/ETP × 100.
Thrombotic APS and oAPS had an increase of global thrombin generation (ETP = 808 nM.min (756-853) vs. 1265 nM.min (956-1741) and 1863 nM.min (1434-2080), respectively) (Peak = 78 nM (74-86) vs. 153 nM (109-215) and 254 nM.min (232-289), respectively). Biological APS had only a lag time increase (T = 4.89 ± 1.65 min vs. 13.6 ± 3.9 min). An increased aPCR was observed in tAPS (52.7 ± 16.4%), oAPS (64.1 ± 14.6%) as compared to the control group (27.2 ± 13.8%).
Our data suggest an increase of thrombin generation in thrombotic and obstetrical APS and no hypercoagulable states in patients with biological APS. The study of a prospective and a larger controlled cohort could determine the TGA useful for APS monitoring and could confirm an aPCR evaluation in PPP.
抗磷脂综合征（APS）与血栓形成事件（tAPS）和/或产科并发症（oAPS）相关，伴有持续存在的抗磷脂抗体（aPL）。尽管2006年对aPL进行了更新，但仍有一些患者出现典型临床事件却不符合经典生物学标准。我们研究的目的是通过凝血酶生成（TG）曲线和活化蛋白C抵抗（aPCR）来评估不同类型APS的高凝状态。
我们回顾性纳入了41例符合悉尼标准分类（tAPS、oAPS）且无APS临床表现但aPL持续存在的患者（生物学APS）。使用Fluoroskan Ascent荧光计在乏血小板血浆（PPP）中进行凝血酶生成测定。以活化蛋白C抵抗率进行测量：ETP/ETP×100。
血栓形成性APS和oAPS的总体凝血酶生成增加（ETP分别为808 nM·min（756 - 853）、1265 nM·min（956 - 1741）和1863 nM·min（1434 - 2080））（峰值分别为78 nM（74 - 86）、153 nM（109 - 215）和254 nM·min（232 - 289））。生物学APS仅凝血酶生成延迟时间增加（T = 4.89±1.65分钟对13.6±3.9分钟）。与对照组（27.2±13.8%）相比，tAPS（52.7±16.4%）和oAPS（64.1±14.6%）中观察到aPCR增加。
我们的数据表明血栓形成性和产科性APS中凝血酶生成增加，而生物学APS患者无高凝状态。对前瞻性和更大规模对照队列的研究可以确定对APS监测有用的TGA，并可以证实对PPP中aPCR的评估。
