OUP accepted manuscript
OUP accepted manuscript
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DOI：
10.1093/rheumatology/keac264
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发表时间：
2022
期刊：
影响因子：
5.5
通讯作者：
中科院分区：
文献类型：
--
作者：
目的血小板减少是急性呼吸窘迫综合征患者常见的临床表现，可作为血栓复发、产科事件和严重的院外事件的独立预测指标。血小板减少定义为血小板计数<10 0 × 10 9/L。结果队列中74例(33.94%)为血小板减少症，14 4例为血小板计数正常。基线特征比较显示，血小板减少的患者有更多的内脏静脉血栓[10(13.51%)vs5(3.47%)；P= 0.009]和表外表现[主要是溶血性贫血；20(27.03%)vs17(11.81%)；P= 0.007]。低补体血症更多见于有血小板减少的患者[19例(25.68%)，VS16例(11.11%)；P= 0.01]。血小板减少者以ACLIg G/Ig M、抗β2糖蛋白I和狼疮抗凝剂阳性者多见。在生存分析中，血栓、产科和严重的院外存活率在有血小板减少的患者中显著较差。在多因素COX回归分析中，血小板减少是所有终点事件的独立危险因素，包括血栓事件[危险比(HR)2.93(95%CI 1.31，6.56)，P= 0.009]、妊娠率[HR 8.00(95%CI 2.43，26.37)，P= 0.0006]和严重体外事件[HR 15.27(95%CI 1.85,125.98)，P= 0.0006]。
ObjectivesThrombocytopenia, a frequent clinical manifestation in patients with APS, could be an independent predictor of recurrent thrombotic, obstetric and severe extracriteria events.MethodsThis single-centre prospective study enrolled 218 consecutive patients diagnosed with primary APS between 2010 and 2021. Thrombocytopenia was defined as a platelet count less than 100 × 109/L.ResultsOur cohort included 74 (33.94%) patients with thrombocytopenia and 144 patients with a continuous normal platelet count. Comparison of baseline characteristics indicated that patients with thrombocytopenia had more visceral venous thromboses [10 (13.51%)vs5(3.47%);P= 0.009] and extracriteria manifestations [mainly haemolytic anaemia; 20 (27.03%)vs17 (11.81%);P= 0.007]. Hypocomplementemia was more likely among patients with thrombocytopenia [19 (25.68%)vs16 (11.11%);P= 0.01]. The presence of aCL-IgG/IgM, anti-β2-glycoprotein I and lupus anticoagulant were more frequently detected in patients with thrombocytopenia. In survival analysis, thrombotic, obstetric and severe extracriteria survival rates were significantly worse in patients with thrombocytopenia. In multivariate Cox regression, thrombocytopenia was an independent risk factor for all endpoint events, including thrombotic events [hazard ratio (HR) 2.93 (95% CI 1.31, 6.56),P= 0.009], pregnancy morbidity [HR 8.00 (95% CI 2.43, 26.37),P= 0.0006] and severe extracriteria events [HR 15.27 (95% CI 1.85, 125.98),P= 0.01].ConclusionThrombocytopenia could identify primary APS patients at high risk of developing thrombotic events, pregnancy morbidity and severe extracriteria events.