Gamal Sherif, Mohamed Samar, Moghazy Abdelkawy
Department of Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Arch Rheumatol. 2022 Jan 23;37(2):252-260. doi: 10.46497/ArchRheumatol.2022.9088. eCollection 2022 Jun.
This study aims to evaluate the prevalence of thrombocytopenia in a cohort of patients with primary and secondary antiphospholipid syndrome (APS) and to examine the relation of thrombocytopenia to the clinical, laboratory findings, and damage index for antiphospholipid syndrome (DIAPS).
Between August 2018 and February 2019, a total of 168 patients (16 males, 152 females; mean age: 32.5±8.4 years; range, 18 to 59 years) who were followed in our clinic for APS were retrospectively analyzed. Medical records of the patients were screened and clinical data, laboratory investigations, and treatments applied were recorded. The DIAPS was calculated for all patients. The patients were divided into two groups according to the presence or absence of thrombocytopenia and both groups were compared regarding clinical, laboratory findings and DIAPS. Further subgroup analysis was done for patients with primary APS.
The most common clinical manifestations in our patients were obstetric manifestations (77.4% in pregnant women), musculoskeletal manifestations (69%) and peripheral vascular thrombosis (54.8%). The prevalence of thrombocytopenia in our study was 42.3%, and it was significantly associated with musculoskeletal manifestations (p=0.043), vascular thrombosis (p=0.043), neurological manifestations (p=0.030), cutaneous manifestations (p=0.006), and use of immunosuppressives (p=0.047). The DIAPS was significantly higher in the thrombocytopenia group (p=0.034). Further subgroup analysis of patients with primary APS revealed that neurological manifestations (p=0.010) were significantly higher in the thrombocytopenia group, while the DIAPS was higher in the thrombocytopenia group, but it did not reach statistical significance (p=0.082).
Thrombocytopenia may be associated with a higher incidence of vascular thrombosis, neurological manifestations, musculoskeletal manifestations, use of immunosuppressive treatment, and DIAPS. In primary APS patients, thrombocytopenia may be a risk for neurological manifestations.
本研究旨在评估原发性和继发性抗磷脂综合征（APS）患者队列中血小板减少症的患病率，并探讨血小板减少症与抗磷脂综合征的临床、实验室检查结果及损伤指数（DIAPS）之间的关系。
回顾性分析2018年8月至2019年2月期间在我院门诊随访的168例APS患者（男16例，女152例；平均年龄：32.5±8.4岁；范围18至59岁）。筛查患者的病历，记录临床资料、实验室检查及应用的治疗方法。计算所有患者的DIAPS。根据是否存在血小板减少症将患者分为两组，并比较两组的临床、实验室检查结果及DIAPS。对原发性APS患者进行进一步亚组分析。
我们患者中最常见的临床表现为产科表现（孕妇中占77.4%）、肌肉骨骼表现（69%）和外周血管血栓形成（54.8%）。本研究中血小板减少症的患病率为42.3%，且与肌肉骨骼表现（p = 0.043）、血管血栓形成（p = 0.043）、神经表现（p = 0.030）、皮肤表现（p = 0.006）及免疫抑制剂的使用（p = 0.047）显著相关。血小板减少症组的DIAPS显著更高（p = 0.034）。原发性APS患者的进一步亚组分析显示，血小板减少症组的神经表现（p = 0.010）显著更高，而血小板减少症组的DIAPS更高，但未达到统计学意义（p = 0.082）。
血小板减少症可能与血管血栓形成、神经表现、肌肉骨骼表现、免疫抑制治疗的使用及DIAPS的发生率较高有关。在原发性APS患者中，血小板减少症可能是神经表现的一个风险因素。
