Division of Rheumatology, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkiye.
Department of Immunology, Aziz Sancar Institute of Experimental Medicine, İstanbul University, İstanbul, Turkiye.
Turk J Med Sci. 2023 Sep 13;53(5):1067-1074. doi: 10.55730/1300-0144.5671. eCollection 2023.
BACKGROUND/AIM: In this cross-sectional study, it was aimed to test the predictive value of noncriteria antiphospholipid antibodies (aPL) in addition to the global antiphospholipid syndrome score (GAPSS) in predicting vascular thrombosis (VT) in a cohort of patients with APS and aPL (+) systemic lupus erythematosus (SLE).
This study included 50 patients with primary APS, 68 with SLE/APS, and 52 with aPL (+) SLE who were classified according to VT as VT ± pregnancy morbidity (PM), PM only or aPL (+) SLE. Antiphospholipid serology consisting of lupus anticoagulant (LA), anticardiolipin (aCL) immunoglobulin G (IgG)/IgM/IgA, antibeta2 glycoprotein I (aβ2GPI) IgG/IgM/IgA, antiphosphatidylserine/prothrombin (aPS/PT) IgG/IgM and antidomain-I (aDI) IgG was determined for each patient. The GAPSS and adjusted GAPSS (aGAPSS) were calculated for each patient, as previously defined. Logistic regression analysis was carried out with thrombosis as the dependent variable and high GAPSS, aCL IgA, aβ2GPI IgA, and aDI IgG as independent variables.
The mean GAPSS and aGAPSS of the study population were 11.6 ± 4.4 and 9.6 ± 3.8. Both the VT ± PM APS (n = 105) and PM only APS (n = 13) groups had significantly higher GAPSS and aGAPSS values compared to the aPL (+) SLE (n = 52) group. The patients with recurrent thrombosis had higher aGAPSS but not GAPSS than those with a single thrombotic event. The computed area under the receiver operating characteristic curve demonstrated that a GAPSS ≥13 and aGAPSS ≥10 had the best predictive values for thrombosis. Logistic regression analysis including a GAPSS ≥13, aCL IgA, aβ2GPI IgA, and aDI IgG showed that none of the factors other than a GAPSS ≥13 could predict thrombosis.
Both the GAPSS and aGAPSS successfully predict the thrombotic risk in aPL (+) patients and aCL IgA, aβ2GPI IgA, and aDI IgG do not contribute to high a GAPSS or aGAPSS.
背景/目的：在这项横断面研究中，旨在测试非标准抗磷脂抗体（aPL）在预测血管血栓形成（VT）方面的预测价值，这些抗体除了全球抗磷脂综合征评分（GAPSS）外，还存在于抗磷脂综合征（APS）和抗磷脂抗体（aPL）阳性的系统性红斑狼疮（SLE）患者中。
本研究纳入了 50 例原发性 APS 患者、68 例 SLE/APS 患者和 52 例 aPL（+）SLE 患者，根据 VT 将其分为 VT ±妊娠并发症（PM）、PM 仅发生或 aPL（+）SLE。抗磷脂抗体谱包括狼疮抗凝物（LA）、抗心磷脂（aCL）免疫球蛋白 G（IgG）/IgM/IgA、抗β2 糖蛋白 I（aβ2GPI）IgG/IgM/IgA、抗磷脂酰丝氨酸/凝血酶原（aPS/PT）IgG/IgM 和抗域 I（aDI）IgG，为每位患者确定。如前所述，计算每位患者的 GAPSS 和调整后的 GAPSS（aGAPSS）。以血栓形成为因变量，以高 GAPSS、aCL IgA、aβ2GPI IgA 和 aDI IgG 为自变量，进行逻辑回归分析。
研究人群的平均 GAPSS 和 aGAPSS 分别为 11.6 ± 4.4 和 9.6 ± 3.8。VT ± PM APS（n = 105）和 PM 仅 APS（n = 13）组的 GAPSS 和 aGAPSS 值均显著高于 aPL（+）SLE（n = 52）组。复发性血栓形成患者的 aGAPSS 高于单次血栓形成事件患者，但 GAPSS 无差异。计算接受者操作特征曲线下的面积表明，GAPSS≥13 和 aGAPSS≥10 对血栓形成具有最佳预测价值。包括 GAPSS≥13、aCL IgA、aβ2GPI IgA 和 aDI IgG 的逻辑回归分析表明，除 GAPSS≥13 外，其他因素均不能预测血栓形成。
GAPSS 和 aGAPSS 均可成功预测 aPL（+）患者的血栓形成风险，而 aCL IgA、aβ2GPI IgA 和 aDI IgG 并不能增加 GAPSS 或 aGAPSS 的水平。
