A Followup study of antiphospholipid antibodies and associated neuropsychiatric manifestations in 137 children with systemic lupus erythematosus
A Followup study of antiphospholipid antibodies and associated neuropsychiatric manifestations in 137 children with systemic lupus erythematosus
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DOI：
10.1002/art.23334
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发表时间：
2008-02-15
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影响因子：
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通讯作者：
Silverman, Earl D.
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文献类型：
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作者：
Avcin, Tadej;Benseler, Susanne M.;Silverman, Earl D.
目标。目的：测定抗心磷脂抗体（aCL）、抗β(2)-糖蛋白I（抗β (2)GPI）抗体和狼疮抗凝剂（LAC）在系统性红斑狼疮（SLE）患儿中的患病率，并评估其与神经精神症状的关系。对137例SLE患儿（男25例，女112例，诊断时平均年龄13.0岁）的抗磷脂抗体（aPL）进行了纵向随访的单中心回顾性队列研究。患者平均随访31个月。在诊断时，65%的儿童aCL阳性，41%的儿童抗β (2)GPI抗体阳性，26%的儿童LAC阳性。分析aPL的存在与诊断时个体神经精神表现的关系，LAC阳性与脑血管疾病的相关性有统计学意义（5例，P = 0.015）。随着时间的推移，50%的儿童aCL持续阳性，29%的儿童抗β (2)GPI抗体持续阳性，16%的儿童LAC持续阳性。发现抗β (2)GPI抗体的患病率，但未发现aCL和LAC。有神经精神疾病的儿童与无神经精神疾病的儿童相比，有统计学显著性增高（P = 0.02）。特异性神经精神表现的比较显示，LAC持续阳性与舞蹈病有统计学意义（2例，P = 0.02）。研究发现，与没有神经精神疾病的SLE患者相比，合并神经精神疾病的SLE患者中抗- β (2)GPI抗体的患病率更高。我们的数据表明LAC与SLE诊断时的脑血管疾病和病程中的舞蹈病之间存在关联，但aPL与其他神经精神表现之间没有关联。
Objective. To determine the prevalence of anticardiolipin antibodies (aCL), anti-beta(2)-glycoprotein I (anti-beta(2)GPI) antibodies, and lupus anticoagulant (LAC) in a large cohort of children with systemic lupus erythematosus (SLE), and to evaluate the associations with neuropsychiatric manifestations.Methods. A single-center retrospective cohort study with longitudinal followup of antiphospholipid antibodies (aPL) in 137 children with SLE (25 boys and 112 girls, mean age at diagnosis 13.0 years) was performed. Patients were followed up for a mean of 31 months.Results. At the time of diagnosis, 65% of the children were aCL positive, 41% had anti-beta(2)GPI antibodies, and 26% were LAC positive. Analysis of the association between presence of aPL and individual neuropsychiatric manifestations at diagnosis showed a statistically significant association of positive LAC with cerebrovascular disease (5 patients; P = 0.015). A persistently positive aCL was observed in 50%, anti-beta(2)GPI antibodies in 29%, and LAC in 16% of children over time. The prevalence of anti-beta(2)GPI antibodies, but not aCL and LAC, was found. to be statistically significantly higher in children with neuropsychiatric disease compared with those without (P = 0.02). Comparison for specific neuropsychiatric manifestations showed a statistically significant association between a persistently positive LAC and chorea (2 patients; P = 0.02).Conclusion. The prevalence of anti-beta(2)GPI antibodies was found to be higher in the group of SLE patients with neuropsychiatric disease compared with those without. Our data suggest an association between LAC and cerebrovascular disease at the time of SLE diagnosis and chorea over the disease course, but not between aPL and other neuropsychiatric manifestations.