Huang Yongfa, Liu Huazhen, Qi Wanting, Du Le, Li Mengtao, Zeng Xiaofeng, Guo Xiaoxiao, Zhao Jiuliang, Zhang Shuyang
Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Front Cardiovasc Med. 2022 Jul 4;9:895098. doi: 10.3389/fcvm.2022.895098. eCollection 2022.
This study aimed to investigate whether there are sex differences in clinical characteristics and prognosis in patients with primary thrombotic antiphospholipid syndrome (ptAPS).
From January 2013 to July 2021, 154 consecutive patients diagnosed with ptAPS were prospectively recruited. Multivariable Cox regression was used to evaluate the association between gender and the composite endpoint including thromboembolic recurrence or all-cause death during follow-up.
Totally, 80 (52%) male and 74 (48%) female patients with ptAPS were included, and men had a higher percentage of smokers/ex-smokers [50 (62%) vs. 6 (8%), < 0.001] and hyperhomocysteinemia [26 (32%) vs. 9 (12%), = 0.003]. The baseline thromboembolic events were similar in two genders, except for limb ischemia [15 (19%) in men vs. 1 (1%) in women, < 0.001]. During a median follow-up of 42 months, the composite endpoint occurred in 30 (38%) male and 15 (20%) female patients ( = 0.019). Male gender [HR 2.499, 95% CI (1.316, 4.743), = 0.005] and warfarin administration [HR 0.482, 95% CI (0.257, 0.905), = 0.023] remained independent risk factors for the composite endpoint. Male gender [HR 3.699, 95% CI (1.699, 8.246), = 0.001] and isolated lupus anticoagulant positivity [HR 2.236, 95% CI (1.039, 4.811), = 0.040] were independent risk factors for thromboembolic recurrence.
There are sex disparities in the clinical characteristics in patients with ptAPS and the male gender is an independent risk factor for the poor prognosis. Male patients with isolated lupus anticoagulant (LA) positivity have the highest risk of thromboembolic recurrence.
本研究旨在调查原发性血栓性抗磷脂综合征（ptAPS）患者的临床特征和预后是否存在性别差异。
2013年1月至2021年7月，前瞻性纳入154例连续诊断为ptAPS的患者。采用多变量Cox回归评估性别与随访期间包括血栓栓塞复发或全因死亡的复合终点之间的关联。
共纳入80例（52%）男性和74例（48%）女性ptAPS患者，男性吸烟者/既往吸烟者的比例更高[50例（62%）对6例（8%），<0.001]，高同型半胱氨酸血症的比例也更高[26例（32%）对9例（12%），=0.003]。除肢体缺血外，两性的基线血栓栓塞事件相似[男性15例（19%）对女性1例（1%），<0.001]。在中位随访42个月期间，30例（38%）男性和15例（20%）女性患者发生了复合终点事件（=0.019）。男性[风险比（HR）2.499，95%置信区间（CI）（1.316，4.743），=0.005]和华法林治疗[HR 0.482，95%CI（0.257，0.905），=0.023]仍然是复合终点的独立危险因素。男性[HR 3.699，95%CI（1.699，8.246），=0.001]和单纯狼疮抗凝物阳性[HR 2.236，95%CI（1.039，4.811），=0.040]是血栓栓塞复发的独立危险因素。
ptAPS患者的临床特征存在性别差异，男性是预后不良的独立危险因素。单纯狼疮抗凝物（LA）阳性的男性患者血栓栓塞复发风险最高。
