Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Clin Rheumatol. 2021 Nov;40(11):4581-4588. doi: 10.1007/s10067-021-05843-z. Epub 2021 Jul 2.
Platelet activation is a possible pathogenic process contributing to thromboembolism in antiphospholipid syndrome (APS), and platelet distribution width (PDW) is associated with platelet activation. The objective of this study was to evaluate the association between platelet indices and thrombotic events in patients with primary APS.
This single-center cross-sectional study included 207 consecutive patients with APS treated at our institution between 2010 and 2019. Results of blood tests were recorded retrospectively from medical records.
Of the included patients, 135 (65.2%) were female and 72 (34.8%) were male. They were classified into thrombotic (n = 150) or non-thrombotic (n = 57) groups. PDW, mean platelet volume, and large platelet ratio were significantly higher in the thrombotic group. In univariate logistic analysis, PDW was significantly associated with an increased odds of thrombosis [odds ratio (OR) 1.554, 95% confidence interval (CI) 1.289-1.873, p<0.001]. In multivariate logistic analysis, PDW and positive lupus anticoagulant (LA) were risk factors for thrombosis. Receiver operating characteristic analysis showed that PDW, combined with a positive LA, was a reliable indicator of thrombosis, with an area under the curve of 0.796 (95% CI 0.728-0.864). The optimal cutoff value for PDW was 12.4 fl, with a sensitivity of 72.0% and specificity of 77.2%. Multivariate logistic regression of PDW tertiles showed that the odds of thrombosis increased abruptly in the highest tertile.
This study confirmed the association between PDW and thrombotic events in APS patients, supporting the theory that platelet activation is a crucial mechanism of thrombosis in APS. Key Points • This study is the first to discuss the correlation between PDW and thromboses in patients with APS. • This study provides evidence of the important role of platelet activation in the pathogenesis of APS.
血小板活化可能是抗磷脂综合征（APS）中血栓形成的致病过程，血小板分布宽度（PDW）与血小板活化有关。本研究旨在评估原发性 APS 患者血小板指数与血栓事件之间的关系。
这是一项单中心的横断面研究，纳入了 2010 年至 2019 年在我院治疗的 207 例连续 APS 患者。回顾性地从病历中记录血液检查结果。
纳入的患者中，135 例（65.2%）为女性，72 例（34.8%）为男性。他们被分为血栓组（n=150）和非血栓组（n=57）。血小板分布宽度、平均血小板体积和大血小板比例在血栓组中显著升高。在单变量逻辑分析中，血小板分布宽度与血栓形成的可能性增加显著相关[比值比（OR）1.554，95%置信区间（CI）1.289-1.873，p<0.001]。在多变量逻辑分析中，血小板分布宽度和狼疮抗凝剂（LA）阳性是血栓形成的危险因素。受试者工作特征（ROC）分析显示，血小板分布宽度与 LA 联合使用是血栓形成的可靠指标，曲线下面积为 0.796（95%CI 0.728-0.864）。血小板分布宽度的最佳截断值为 12.4 fl，灵敏度为 72.0%，特异性为 77.2%。血小板分布宽度三分位的多变量逻辑回归显示，最高三分位的血栓形成几率急剧增加。
本研究证实了血小板分布宽度与 APS 患者血栓事件之间的关联，支持了血小板活化是 APS 血栓形成的关键机制的理论。
本研究首次探讨了血小板分布宽度与 APS 患者血栓形成之间的相关性。
本研究为血小板活化在 APS 发病机制中的重要作用提供了证据。
