Ludia C, Domenico P, Monia C, Emilia A, Sandra F, Agatina A L, Massimo M, Cristina G, Piero D R, Ignazio S, Rosanna A, Franco G G
Istituto di Clinica Medica Generale e Cardiologia, Universita' di Firenze, Florence, Italy.
Autoimmunity. 1998;27(3):141-8. doi: 10.3109/08916939809003861.
Antiphospholipid antibodies (aPL) have been found to be associated with arterial and venous thrombosis. Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for ischaemic heart disease (IHD), which is still affected by restenosis at a rate of 20-30%. This study was aimed at investigating the possible role of aPL in restenosis after PTCA. In sixty consecutive IHD patients, aPL (lupus anticoagulant -LA- and anticardiolipin antibodies -aCL) and markers of haemostatic activation were investigated before PTCA, and patients were followed up for restenosis. No infections, autoimmune disease or treatment by drugs that may alter aPL levels occurred in any of the patients. aPL were found in 15/60 patients: aCL in 7/60, LA in 5/60 and aCL and LA in 3/60. No statistically significant difference was found between aPL negative and aPL positive patients in pre PTCA plasma levels of prothrombin activation fragment (F1+2) 1.4 nmol/l (0.3-5.71) vs 1.4 nmol/l (0.9-4.0), thrombin-antithrombin complex (TAT) 4.0 microg/l (1.1-34.2) vs 5.2 microg/l (2.1-60.0), D-dimer (DD) 25 ng/ml (2-515) vs 44 ng/ml (2-160) or plasminogen activator inhibitor activity (PAI) 4.8 IU/ml (2.5-36.4) vs 4.4 IU/ml (2.5-13.4). Restenosis was observed in 13/60 patients (7/45-15% - aPL negative and 6/15-40% - aPL positive patients) who underwent angiographic tests after PTCA because of recurring angina or positive exercise test. Restenosis occurred after 2.2 months (0.5-3) in aPL positive patients and after 3.5 months (1-12.8) in aPL negative. These results suggest that 1) restenosis with recurrent ischaemia occurs more frequently in aPL positive than in aPL negative patients, 2) in aPL positive patients restenosis occurs earlier, and 3) the presence of aPL is not associated with hypercoagulability.
抗磷脂抗体（aPL）已被发现与动脉和静脉血栓形成有关。经皮腔内冠状动脉成形术（PTCA）是治疗缺血性心脏病（IHD）的一种既定疗法，但其仍受再狭窄影响，再狭窄发生率为20%-30%。本研究旨在调查aPL在PTCA术后再狭窄中可能发挥的作用。在60例连续的IHD患者中，于PTCA术前检测了aPL（狼疮抗凝物-LA-和抗心磷脂抗体-aCL）及止血激活标志物，并对患者进行再狭窄随访。所有患者均未发生感染、自身免疫性疾病或使用可能改变aPL水平的药物进行治疗。60例患者中有15例检测到aPL：7例检测到aCL，5例检测到LA，3例同时检测到aCL和LA。在PTCA术前，aPL阴性和aPL阳性患者的血浆凝血酶原激活片段（F1+2）水平[1.4 nmol/L（0.3-5.71）对1.4 nmol/L（0.9-4.0）]、凝血酶-抗凝血酶复合物（TAT）水平[4.0 μg/L（1.1-34.2）对5.2 μg/L（2.1-60.0）]、D-二聚体（DD）水平[25 ng/ml（2-515）对44 ng/ml（2-160）]或纤溶酶原激活物抑制剂活性（PAI）水平[4.8 IU/ml（2.5-36.4）对4.4 IU/ml（2.5-13.4）]均无统计学显著差异。因复发性心绞痛或运动试验阳性而在PTCA术后接受血管造影检查的60例患者中，有13例发生再狭窄（45例aPL阴性患者中有7例-15%，15例aPL阳性患者中有6例-40%）。aPL阳性患者在2.2个月（0.5-3）后发生再狭窄，aPL阴性患者在3.5个月（1-12.8）后发生再狭窄。这些结果表明：1）aPL阳性患者比aPL阴性患者更易发生伴有复发性缺血的再狭窄；2）aPL阳性患者再狭窄发生更早；3）aPL的存在与高凝状态无关。
