抗磷脂抗体在白塞病合并血栓中的临床意义

doi:10.19723/j.issn.1671-167X.2024.06.014

Abstract

Abstract:

Objective: To investigate the distribution and clinical significance of antiphospholipid antibody (aPL) in patients with Behcet disease (BD). Methods: A total of 222 BD patients admitted to the Department of Rheumatology and Immunology in Peking University People' s Hospital from February 2008 to July 2024 were selected retrospectively. General data of the patients including age and gender were collec-ted. Clinical manifestations (including oral ulcers, genital ulcers, and thrombosis) and laboratory indexes (including aPL, human leukocyte antigen-B51, and anti-endothelial cell antibody) were collec-ted. The recurrence of thrombosis in the BD patients with thrombosis was followed up. Chi-square test was used to compare the clinical symptoms and laboratory indicators between aPL positive group and aPL negative group. Log-rank test was used to compare the recurrence rates of the aPL positive group and the aPL negative group, and P correction was performed by Two-stage method. Finally, Graphpad prism was used for plotting. Results: The prevalence of single aPL, double aPL and triple aPL positivity in the BD patients were 22.1%, 0.5% and 1.4%, respectively. The positive rates of anti-cardiolipin antibody, anti-β2 glycoprotein Ⅰ antibody and lupus anticoagulant (LAC) were 10.4%, 1.8% and 13.1%, respectively. The incidence of thrombosis in the aPL positive group was significantly higher than that in the aPL negative group (44.9% vs. 16.9%, P < 0.001). The erythrocyte sedimentation rate [(20.78±4.91) mm/h vs. (15.85±4.29) mm/h, P=0.005], C-reactive protein [(12.97±5.17) mg/L vs. (7.49± 4.22) mg/L, P=0.010] and IgM [(1.55±0.95) g/L vs. (1.12±0.72) g/L, P < 0.001] in the aPL positive group were significantly higher than those in the aPL negative group. LAC positivity was an independent risk factor for thrombosis in the BD patients (OR=8.51, 95%CI: 2.71-26.72, P < 0.001). The recurrence rate of the aPL positive group was higher than that of the aPL negative group, but there was no statistical difference (69.23% vs. 52.17%, P=0.932). Conclusion: Positive LAC and aneurysm are independent risk factors for thrombosis in BD patients. At the same time, positive antiphospholipid antibody can also significantly increase the risk of thrombosis in BD patients, which has important significance for guiding the treatment of BD.

Key words: Antiphospholipid antibody, Behcet disease, Thrombosis, Recurrence, Risk factors

CLC Number:

R593.2

Yukai LI, Hongyan WANG, Liang LUO, Yun LI, Chun LI. Clinical significance of antiphospholipid antibodies in Behcet disease with thrombosis[J].Journal of Peking University (Health Sciences), 2024, 56(6): 1036-1040.

Figures/Tables 5

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References 15

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Items	BD patients (n=222)
Age/years	41.5±13.1
Gender (female)	112 (50.5)
Thrombosis
Venous thrombosis	36 (16.2)
Arterial thrombosis	27 (12.2)
Both venous and arterial thrombosis	11 (5.0)
aCL (+)	23 (10.4)
aβ2GPI (+)	4 (1.8)
LAC (+)	29 (13.1)
Single aPL positivity	49 (22.1)
Double aPL positivity	1 (0.5)
Triple aPL positivity	3 (1.4)

Items	aPL (+) (n=49), n (%)	aPL (-) (n=173), n (%)	P value
Oral ulcers	46 (93.9)	167 (97.1)	0.288
Vulvar ulcers	21 (42.9)	106 (61.6)	0.019
Articular involvement	5 (10.2)	45 (26.0)	0.019
Neurologic involvement	6 (12.2)	24 (13.9)	0.769
Skin manifestations	13 (26.5)	62 (35.8)	0.224
Ocular involvement	9 (18.4)	47 (27.2)	0.211
Positive pathergy test	5 (16.1)	32 (30.8)	0.109
Thrombosis	22 (44.9)	29 (16.9)	< 0.001
Aneurysms	7 (14.3)	23 (13.4)	0.869
Gastrointestinal involvement	3 (6.1)	37 (21.4)	0.014

Items	aPL (+)(n=49), ${\bar x}$±s	aPL (-)(n=173), ${\bar x}$±s	P value
IgA/(g/L)	3.11±1.30	2.79±1.25	0.335
IgG/(g/L)	13.66±1.96	11.84±1.82	0.140
IgM/(g/L)	1.55±0.95	1.12±0.72	< 0.001
CRP/(mg/L)	12.97±5.17	7.49±4.22	0.010
ESR/(mm/h)	20.78±4.91	15.85±4.29	0.005
PT/s	13.75±1.89	13.01±3.24	0.931
Fib/(mg/dL)	308.26±9.76	328.72±13.99	0.538
APTT/s	33.65±2.26	32.65±5.10	0.653
FDP/(mg/L)	1.72±1.16	2.13±1.63	0.085
D-dimer/(μg/L)	182.91±14.64	256.19±21.36	0.082

Items	Univariate					Multivariate
Items	B	SE	Z	P	OR (95%CI)	B	SE	Z	P	OR (95%CI)
Age/years	0.00	0.01	-0.29	0.770	1.00 (0.97-1.02)
ESR/(mm/h)	0.00	0.01	-0.17	0.868	1.00 (0.98-1.02)
PT/s	0.20	0.08	2.45	0.014	1.22 (1.04-1.43)	0.08	0.09	0.90	0.368	1.09 (0.90-1.31)
Fib/(mg/dL)	0.00	0.00	1.34	0.182	1.00 (1.00-1.00)
APTT/s	0.00	0.01	-0.17	0.868	1.00 (0.98-1.02)
IgA/(g/L)	0.01	0.12	-0.12	0.906	0.99 (0.78-1.25)
IgG/(g/L)	0.05	0.05	0.96	0.337	1.05 (0.95-1.17)
IgM/(g/L)	0.11	0.29	0.39	0.698	1.12 (0.63-1.99)
aβ2GPI (+)	0.25	0.65	-0.39	0.700	0.78 (0.22-2.79)
aCL (+)	2.31	1.24	1.86	0.062	10.06 (0.89-114.09)
LAC (+)	2.20	0.49	4.48	< 0.001	9.06 (3.45-23.76)	2.14	0.58	3.67	< 0.001	8.51 (2.71-26.72)
HLA-B51 (+)	0.59	0.46	1.29	0.196	1.81 (0.74-4.45)
AECA (+)	0.14	0.45	-0.31	0.760	0.87 (0.36-2.11)
Aneurysm	1.05	0.46	2.29	0.022	2.85 (1.16-7.00)	0.99	0.50	1.97	0.049	2.70 (1.01-7.24)

Clinical significance of antiphospholipid antibodies in Behcet disease with thrombosis

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