摘要
目的探讨抗磷脂抗体(aPL)阳性患者在病程中发生血清学转化的情况及可能的影响因素。方法在北京大学第一医院前瞻性队列数据库中筛选2009年1月至2019年10月间aPL持续阳性至少12周、随访时间至少9个月的患者。分析入选患者在随访过程中狼疮抗凝物(LA)、抗心磷脂抗体(aCL)、抗β2糖蛋白I抗体(抗β2GPI)的变化情况,并分析不同aPL血清学转化的影响因素。统计学方法使用χ2检验或Fisher精确检验和Mann Whitney U检验,多因素分析采用Logistic分析。结果本研究共纳入93例患者,25%原发性APS,63%合并SLE。在平均45个月的随访时间里,LA、aCL和抗β2GPI转阴率(2次以上检测阴性,间隔至少12周)分别为11%(9/83),26%(18/69)和24%(13/53)。多因素分析结果表明,LA双法阳性是LA转阴的独立保护性因素[OR=0.055,95%CI(0.006,0.545),P=0.013];aCL中高滴度阳性[OR=0.199,95%CI(0.050,0.798),P=0.023]和aPL基线阳性数量[OR=0.220,95%CI(0.066,0.735),P=0.014]是aCL转阴的独立保护性因素;而合并SLE是aCL转阴的独立危险因素[OR=13.50,95%CI(1.195,152.6),P=0.035]。与aCL结果类似,抗β2GPI中高滴度阳性[OR=0.168,95%CI(0.032,0.872),P=0.034]和aPL基线阳性数量[OR=0.243,95%CI(0.073,0.813),P=0.022]是抗β2GPI转阴的独立保护性因素。基线三抗体阳性的40例患者中未发现与aPL转阴的相关因素。aPL持续阳性与再发血栓/病态妊娠事件无明确相关性。结论aPL存在不同程度的血清学转化,其中aCL的转阴率最高。抗体低滴度阳性、抗体阳性数量少与aCL和抗β2GPI转阴相关。SLE患者中的阳性aCL更容易转阴;LA双法阳性患者多数保持持续阳性。
Objective To explore the clinical and serological evolution of patients with positive antiphospholipid antibodies(aPL),and the factors and therapeutic implications associated with aPL negativization.Methods Patients with a persistent serological positive aPL according to established criteria between 1997 and 2018 were included.The Lupus anticoagulant(LA),anti-cardiolipid antibody(aCL)and anti-β2 glycoproteinⅠ(anti-β2GPⅠ)were tested following the International Society on Thrombosis and Haemostasis guidelines.The patients were classified as aPL negativization if the following aPL tests became negative,on two or more occasions at least 12 weeks apart.Titer more than 40 RU/ml was defined as moderate to high titer for anti-aCL and anti-β2GPⅠ.For patients receiving warfarin,the results of LA were counted only when international normalized ratio(INR)<1.5.Results There were 93 patients finally involved.25%of them were primary APS and 63%were conco-mitant with systemic lupus erythematosus(SLE).After a mean follow-up of 45.0(45.0)months,the percentage of aPL negativization was 11%(9/83),26%(18/69),24%(13/53)for LA,aCL and anti-β2GPⅠrespectively.Multivariate analysis confirmed that double positive of dilute russell's viper venom time(dRVVT)and silica clotting time(SCT)was the only independent protective factor for LA negativization[OR=0.055,95%CI(0.006,0.545);P=0.013].SLE,moderate to high titer of aCL and number of baseline aPL positivity were independently associated with aCL negativization[OR=18.2;95%CI(1.45,228);P=0.025,for SLE;OR=0.217;95%CI(0.053,0.888);P=0.034,for moderate to high titer of aCL;OR=0.198;95%CI(0.057,0.689);P=0.011,for number of baseline aPL positivity].Moderate to high titer of anti-β2GPⅠand number of baseline aPL positivity were independent protective factors for anti-β2GPⅠnegativization[OR=0.168;95%CI(0.032,0.872);P=0.034,for moderate to high titer of anti-β2GPⅠ;OR=0.243;95%CI(0.073,0.813);P=0.022,for number of baseline aPL positivity].There were no factors related with aPL negativization among 40 triple aPL positive patients.We didn't find any relationship between aPL persistent positivity and further thrombosis/pregnancy morbidity due to limited events.Conclusion aPLs negativization is common and frequent for aCL.The number of positive antibodies and higher antibody load are associated with persistently positive serology.Patients with SLE are easier to get aCL negativization.Double positive of dRVVT and SCT was a protective factor for LA negativization.
作者
季兰岚
张卓莉
Ji Lanlan;Zhang Zhuoli(Department of Rheumatology and Immunology,Peking University First Hospital,100034,China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2020年第6期397-402,共6页
Chinese Journal of Rheumatology
关键词
抗磷脂综合征
抗体
抗磷脂
血清学转化
Antiphospholipid syndrome
Antibodies
antiphospholipid
Serologic evolution
