Thrombotic risk stratification by platelet count in patients with antiphospholipid antibodies: a longitudinal study
Thrombotic risk stratification by platelet count in patients with antiphospholipid antibodies: a longitudinal study
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DOI：
10.1111/jth.13763
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发表时间：
2017-09-01
影响因子：
10.4
通讯作者：
Atsumi, T.
中科院分区：
文献类型：
--
作者：
Hisada, R.;Kato, M.;Atsumi, T.
血小板减少是抗磷脂综合征的一种非标准临床表现。然而，血小板减少症是否会增加抗磷脂抗体（aPL）携带者的血栓形成风险仍有待阐明。目的研究血小板计数在预测aPL携带者血栓形成事件方面的影响，并通过结合血小板计数和抗磷脂评分（aPL-S）对血栓形成风险进行分层，aPL-S代表了aPL种类和滴度的量化。对2002年1月至2006年12月期间怀疑患有自身免疫性疾病的953名连续患者进行了纵向研究。结果aPL-S与血小板计数呈负相关（r =-0.2477），aPL-S与血小板计数呈负相关（r =-0.2477）。在aPL阳性患者中，血小板计数低的患者比无血小板计数的患者更容易发生血栓形成（风险比[HR] 2.95，95%置信区间[CI] 1.11-7.88）。在aPL阴性患者中，无论血小板计数如何，血栓形成的预测值均无差异。根据aPL-S将aPL患者进一步分为两个亚组。在低aPL-S患者中，血小板计数低的患者发生血栓形成的频率高于无血小板计数的患者（HR 3.44，95% CI 1.05-11.2）。结论血小板计数低的aPL携带者发生血栓的危险性高。特别地，低aPL-S携带者可以根据血小板计数来分层，以预测未来的血栓形成事件。
Background Thrombocytopenia is a non-criteria clinical manifestation of antiphospholipid syndrome. However, it remains to be elucidated whether thrombocytopenia increases thrombotic risk in antiphospholipid antibody (aPL) carriers.Objectives To investigate the impact of platelet count in terms of predicting thrombotic events in aPL carriers, and to stratify the thrombotic risk by combining platelet count and antiphospholipid score (aPL-S), which represents a quantification of aPL varieties and titers.Patients/methods A single-center, retrospective, longitudinal study comprising 953 consecutive patients who were suspected of having autoimmune disease between January 2002 and December 2006 was performed. Low platelet count was defined as a count of < 150 x 10(3) L-1 at the time of aPL testing.Results A negative correlation was observed between aPL-S and platelet count (r = - 0.2477). Among aPL-positive patients, those with a low platelet count developed thrombosis more frequently than those without (hazard ratio [HR] 2.95, 95% confidence interval [CI] 1.11-7.88). Among aPL-negative patients, no difference was found in the predictive value of thrombosis regardless of platelet count. Patients with aPLs were further divided into two subgroups according to aPL-S. Among low-aPL-S patients, those with low platelet counts developed thrombosis more frequently than those without (HR 3.44, 95% CI 1.05-11.2). In contrast, high-aPL-S patients developed thrombosis frequently regardless of platelet count.Conclusions aPL carriers with low platelet counts are at high risk of developing thrombosis. In particular, low-aPL-S carriers' may be stratified by platelet count in terms of predicting future thrombotic events.