Thrombotic Antiphospholipid Syndrome: Recurrent Thromboses.

IF 0.8 4区 生物学 Q4 BIOCHEMISTRY & MOLECULAR BIOLOGY
T M Reshetnyak, F A Cheldieva, S I Glukhova, K S Nurbaeva, N V Seredavkina, M V Cherkasova, A M Lila, E L Nasonov
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引用次数: 0

Abstract

Thrombotic antiphospholipid syndrome (APS) is a condition affecting young people in whom a thromboembolic event occurs in the presence of circulating antiphospholipid antibodies (aPL).

The aim of this study: was to evaluate the incidence of recurrent thrombosis and its risk factors in antiphospholipid syndrome.

Materials and methods: . The retrospective study included 98 patients with APS who were followed up at the institute from 2014 to 2023, of whom 66 (67%) were women and 32 (33%) were men. Of the 98 patients with APS, 48 (49%) had a diagnosis of systemic lupus erythematosus (SLE). Antiphospholipid antibodies (aPL), including the antibodies to cardiolipin (IgG/IgM aCL), antibodies to ß2glycoprotein 1 (IgG/IgM aß2GP1), antibodies to ß2 glycoprotein IgG against domain 1 (IgG aß2GP1-D1), antibodies to phosphatidylserine/prothrombin complex (IgG/IgM aPS/PT), and other thrombotic risk factors were determined. aPL was assessed by enzyme-linked immunosorbent assay (ELISA) and chemiluminescence assay (CLA).

Results: : Thrombosis recurrence was reported in 62 (63%) of 98 patients, and in 36 (35%) it was not reported. The main cause of recurrent thrombosis was treatment with direct oral anticoagulants (DOACs). Twenty-four (38.7%) of  62 patients with recurrent thrombosis were treated with DOACs, the duration of which ranged from 6 to 24 months. The next most common cause of recurrent thrombosis was the lack of continuous anticoagulant therapy in 20 (32.5%) patients. In 17 (27.4%) patients, recurrence occurred while they were still taking warfarin. In 10 (41.7%) of the 24 patients, the recurrent thrombosis was arterial in origin. This was associated with recurrent cerebral circulation problems. The level of positivity for aPL did not matter, but all of them had triple IgG-aPL positivity. Five patients had lupus anticoagulant (LA) at the onset of the disease before anticoagulant therapy. IgG-aPS/PT was most important in association with recurring thrombosis in the ELISA: 45 (72.6%) of 62 patients with recurring thrombosis were positive for IgG-aPS/PT as compared with 19 (52.8%) of 36 patients without recurring thrombosis. The detection of all aPLs was more frequent in CLA than in ELISA. However, the determination of aPL by ELISA is recommended according to the latest classification criteria. Triple positivity for IgG aCL, IgG aß2GP1, and IgG aß2GP1-D1 according to CLA data remained a risk factor for recurrent thrombosis and increased the risk of recurrence more than 3 times. Obesity was a risk factor for recurrent thrombosis, with a 5-fold increased risk of recurrent thrombosis in obese patients compared to the non-obese ones (p = 0.01).

Conclusions: . Recurrent thrombosis in APS is largely associated with IgG aCL, IgG aß2GP1, IgG aß2GP1-D1, and IgG aPS/PT. Triple IgG aPL positivity in any combination significantly increased recurrent thrombosis risk. The presence of any type of IgG aPL in both ELISA and CLA influenced the recurrence rate of thrombosis in APS. Obesity was a significant risk factor for recurrent thrombosis.

血栓性抗磷脂综合征:复发性血栓。
血栓性抗磷脂综合征(APS)是一种影响年轻人的疾病,在循环抗磷脂抗体(aPL)存在的情况下发生血栓栓塞事件。本研究的目的是评价抗磷脂综合征患者血栓复发的发生率及其危险因素。材料与方法:。回顾性研究纳入了2014年至2023年在该研究所随访的98例APS患者,其中66例(67%)为女性,32例(33%)为男性。在98例APS患者中,48例(49%)诊断为系统性红斑狼疮(SLE)。检测抗磷脂抗体(aPL),包括心磷脂抗体(IgG/IgM aCL)、ß2糖蛋白1抗体(IgG/IgM aß2GP1)、ß2糖蛋白IgG抗结构域1抗体(IgG aß2GP1- d1)、磷脂酰丝氨酸/凝血酶原复合物抗体(IgG/IgM aPS/PT)等血栓形成危险因素。采用酶联免疫吸附法(ELISA)和化学发光法(CLA)评价aPL。结果:98例患者中62例(63%)报告血栓复发,36例(35%)未报告血栓复发。血栓复发的主要原因是直接口服抗凝剂(DOACs)。62例复发性血栓患者中24例(38.7%)采用DOACs治疗,疗程6 ~ 24个月。在20例(32.5%)患者中,血栓复发的第二大常见原因是缺乏持续抗凝治疗。17例(27.4%)患者在服用华法林期间发生复发。24例患者中有10例(41.7%)复发血栓起源于动脉。这与反复出现的脑循环问题有关。aPL阳性水平无关,但均为IgG-aPL的三倍阳性。5例患者在抗凝治疗前在发病时使用狼疮抗凝剂(LA)。ELISA结果显示,IgG-aPS/PT与复发性血栓的相关性最大:62例复发性血栓患者中有45例(72.6%)IgG-aPS/PT阳性,而36例非复发性血栓患者中有19例(52.8%)IgG-aPS/PT阳性。CLA中所有apl的检测频率高于ELISA。然而,根据最新的分类标准,推荐采用ELISA法检测aPL。CLA数据显示IgG aCL、IgG aß 2gp1和IgG aß 2gp1 - d1三重阳性仍然是血栓复发的危险因素,使复发风险增加3倍以上。肥胖是血栓复发的危险因素,肥胖患者血栓复发的风险是非肥胖患者的5倍(p = 0.01)。结论:。APS复发性血栓形成与IgG aCL、IgG aß2GP1、IgG aß2GP1- d1和IgG APS /PT有很大关系。三IgG aPL阳性的任何组合均显著增加血栓复发的风险。ELISA和CLA中任一类型IgG aPL的存在均影响APS血栓复发率。肥胖是血栓复发的重要危险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Doklady Biochemistry and Biophysics
Doklady Biochemistry and Biophysics 生物-生化与分子生物学
CiteScore
1.60
自引率
12.50%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Doklady Biochemistry and Biophysics is a journal consisting of English translations of articles published in Russian in biochemistry and biophysics sections of the Russian-language journal Doklady Akademii Nauk. The journal''s goal is to publish the most significant new research in biochemistry and biophysics carried out in Russia today or in collaboration with Russian authors. The journal accepts only articles in the Russian language that are submitted or recommended by acting Russian or foreign members of the Russian Academy of Sciences. The journal does not accept direct submissions in English.
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