Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Department of Dermatovenereology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Front Immunol. 2022 Aug 18;13:967178. doi: 10.3389/fimmu.2022.967178. eCollection 2022.
Patients with laboratory or clinical manifestations suggestive of antiphospholipid syndrome (APS) but not fulfilling the classification criteria constitute a clinical challenge. This study aims to compare non-criteria APS (NC-APS) with definite APS in terms of clinical manifestations, therapies, and outcomes.
A systematic review of observational studies comparing definite and NC-APS was performed searching four electronic databases. Data on clinical manifestations, therapies and clinical outcomes was extracted.
Sixteen studies, assessing a total of 3,798 participants, were included. Seven out of 10 studies found no significant difference in the prevalence of arterial or venous thrombosis between definite and NC-APS, with two studies on seronegative APS also finding no difference in thrombosis recurrence. Seven out of 12 studies found no significant difference in the prevalence of obstetric manifestations between groups, with the remaining exhibiting conflicting results. In 9 studies comparing treatment frequency in obstetric patients, all but one described similar treatment frequency, with the percentage of NC-APS treated during pregnancy ranging from 26% to 100%. In 10 studies comparing pregnancy outcomes of NC-APS versus definite APS, 7 found similar successful pregnancies/live births. Additionally, 5 studies described improvement of live births in both groups with treatment, with three signalling aspirin monotherapy as efficacious as combination therapy in NC-APS.
This review hints at an absence of marked differences in most evaluated parameters between definite and NC-APS, emphasizing the value of a more active follow-up of these patients. The low-quality available evidence highlights the need for well-defined NC-APS populations in future studies.
https://www.crd.york.ac.uk/prospero, identifier CRD42020210674.
具有实验室或临床表现提示抗磷脂综合征（APS）但不符合分类标准的患者构成了临床挑战。本研究旨在比较非标准 APS（NC-APS）与明确 APS 在临床表现、治疗和结局方面的差异。
通过检索四个电子数据库，对比较明确 APS 和 NC-APS 的观察性研究进行了系统回顾。提取了临床表现、治疗和临床结局的数据。
共纳入 16 项研究，评估了 3798 名参与者。10 项研究中有 7 项研究发现明确 APS 和 NC-APS 之间动脉或静脉血栓形成的发生率没有显著差异，其中两项关于血清阴性 APS 的研究也发现血栓复发没有差异。12 项研究中有 7 项研究发现两组之间产科表现的发生率没有显著差异，其余研究结果存在差异。在比较产科患者治疗频率的 9 项研究中，除一项外，所有研究均描述了相似的治疗频率，NC-APS 妊娠期间的治疗百分比范围为 26%至 100%。在比较 NC-APS 与明确 APS 妊娠结局的 10 项研究中，有 7 项研究发现相似的成功妊娠/活产率。此外，5 项研究描述了两组治疗后活产率的改善，其中 3 项研究表明阿司匹林单药治疗与 NC-APS 联合治疗同样有效。
本综述表明，在大多数评估参数方面，明确 APS 和 NC-APS 之间没有明显差异，这强调了对这些患者进行更积极随访的重要性。现有低质量证据突出表明，未来研究需要明确界定 NC-APS 人群。
https://www.crd.york.ac.uk/prospero，标识符 CRD42020210674。
