Antibody profile and clinical course in primary anti phospholipid syndrome with pregnancy morbidity
Antibody profile and clinical course in primary anti phospholipid syndrome with pregnancy morbidity
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DOI：
10.1160/th06-05-0287
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发表时间：
2006-09-01
影响因子：
6.7
通讯作者：
Pengo, Vittorio
中科院分区：
文献类型：
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作者：
Ruffatti, Amelia;Tonello, Marta;Pengo, Vittorio
在诊断为I类原发性产科抗磷脂综合征的女性中，临床特征和随后血栓栓塞事件和进一步妊娠失败的风险尚未明确记录。不明原因的产科并发症和没有明确的自身免疫性系统性疾病的妇女进行了狼疮抗凝剂（LA），抗心磷脂（ACL）和IgG/IgM抗人β 2-糖蛋白I（β 2GPI）抗体的检测，并诊断为原发性抗磷脂综合征（APS）的分类类别I的基础上，一个以上的实验室标准存在于任何组合。在平均6.3年的随访期间，对诊断时的特征和随后临床事件的风险因素进行了评价。在研究的600名妇女中，有53人符合产科标准，在诊断时有一次以上的阳性实验室检测。所有女性均为ACL和β 2GPI阳性，16例LA阳性。后一组（三重阳性）具有明显的特征，并且更频繁地经历过既往血栓栓塞（OR= 122.5，95% CI 16-957，p < 0.001）。她们的晚期妊娠丢失率也增加（OR= 16.2，95%CI 0.9-292，p=0.01），诊断时IgG a β 2GPI滴度更高（中位数，第25和第75百分位数分别为118，37-962 vs. 23，18-32，p < 0.0001）。在随访期间，血栓栓塞事件的发生率在三重阳性和/或既往血栓栓塞的女性组中显著较高（OR=57.5，95% CI 2.7-1160，p=0.0004），这是多变量模型中TE的唯一独立预测因素。在47名新怀孕的妇女中，有7名发生了复发性流产。三重阳性和/或既往血栓栓塞再次成为新妊娠失败的唯一独立标志物（OR= 34.4，95%CI 3.5-335.1，p=0.003）。总之，在分类为I类的妊娠发病率的原发性APS中，根据实验室检查可以识别出完全不同的患者组。三重阳性和/或血栓栓塞史可预测新的TE事件和新的妊娠失败。
In women diagnosed as having category I primary obstetric anti-phospholipid syndrome, clinical characteristics and the risk of subsequent thromboembolic events and further unsuccessful pregnancy has not been clearly documented. Women with unexplained obstetric complications and no definite autoimmune systemic diseases were tested for lupus anticoagulant (LA), IgG/IgM anticardiolipin (aCL) and IgG/IgM anti-human beta 2-Glycoprotein I (a beta 2GPI) antibodies and diagnosed as having primary anti-phospholipid syndrome (APS) in classification category I on the basis of more than one laboratory criteria present in any combination. Characteristics at the time of diagnosis and risk factors for subsequent clinical events during a mean follow-up of 6.3 years were evaluated. Fifty-three of 600 women studied were found to fulfil obstetric criteria and had more than one positive laboratory test at the time of diagnosis. All the women were aCL and a beta 2GPI positive, and 16 were also LA positive. This latter group (triple positivity) had distinct features and had more frequently experienced previous thromboembolism (OR= 122.5, 95% Cl 16-957,p < 0.001). They also had an increased rate of late pregnancy loss (OR= 16.2,95% Cl 0.9-292, p=0.01), and a higher IgG a beta 2GPI titer at diagnosis (median, 25(th) and 75(th) percentile were 118, 37-962, vs. 23, 18-32, respectively, p < 0.0001). During follow-up, the rate of thromboembolic events was significantly higher in the group of women with triple positivity and/ or previous thromboembolism (OR=57.5, 95% Cl 2.7-1160, p=0.0004) which were the only independent predictors of TE in the multivariate model. Recurrent pregnancy loss took place in seven out of 47 women who had a new pregnancy. Triple positivity and/or previous thromboembolism were again the only independent markers (OR=34.4,95% Cl 3.5-335.1, p=0.003) of an unsuccessful new pregnancy. In conclusion, in primary APS with pregnancy morbidity in classification category I, quite different groups of patients may be identified on the basis of laboratory tests. Triple positivity and/or a history of thromboembolism predict new TE events and new unsuccessful pregnancies.