Non-conventional antiphospholipid antibodies in patients with clinical obstetrical APS: Prevalence and treatment efficacy in pregnancies

被引:48
作者
Mekinian, Arsene [1 ,2 ]
Bourrienne, Marie-Charlotte [3 ]
Carbillon, Lionel [4 ]
Benbara, Amelie [4 ]
Noemie, Abisror [1 ,2 ]
Chollet-Martin, Sylvie [3 ]
Tigaizin, Ahmed [4 ]
Montestruc, Francois [5 ]
Fain, Olivier [1 ,2 ]
Nicaise-Roland, Pascale [3 ]
机构
[1] Univ Paris 06, Hop St Antoine, AP HP, Sorbonne Univ,Serv Med Interne, F-75012 Paris, France
[2] Univ Paris 06, Hop St Antoine, AP HP, Sorbonne Univ,Inflammat Immunopathol Biotherapy D, F-75012 Paris, France
[3] Hop Bichat Claude Bernard, AP HP, Unite Fonct Immunol Autoimmunite & Hypersensibili, Paris, France
[4] Univ Paris 13, Hop Jean Verdier, AP HP, Serv Gynecol Obstet, Bondy, France
[5] eXYSTAT, Malakoff, France
关键词
Antiphospholipid syndrome; Non-conventional antiphospholipids; Obstetrical complications; Pregnancies treatment; WOMEN; PHOSPHATIDYLETHANOLAMINE;
D O I
10.1016/j.semarthrit.2016.05.006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To describe the prevalence of non-conventional APL in patients with obstetrical APS without conventional APL and the impact of treatment on pregnancy outcome. Methods: Patients with clinical obstetrical criteria were tested for anti-phosphatidylethanolamine (aPE) IgG/M, anti-prothrombin/phosphatidylserine (anti-PS/PT) IgG/M, and anti-annexin V IgG. Pregnancy losses rates were compared between APS, non-conventional APS, and non-APL and in untreated pregnancies to treated ones for each group. Results: Using the cutoffs (ROC), 65/96 (68%) patients have been considered as non-conventional APS and compared to 83 APS and 31 patients without APL. The obstetrical history in non-conventional APS did not differ in comparison to confirmed APS. The frequencies of anti-annexin V IgG antibodies tended to be more frequent in non-conventional APS (88% versus 73%; p = 0.06), and those of anti-PE IgG and M were similar. The anti-PS/PT IgG and M antibodies were more frequent in confirmed APS than in non conventional APS (63% and 37% versus 4% and 5%, respectively, p < 0.0001). Overall, 261 pregnancies in patients with non-conventional APS were compared with 81 pregnancies of confirmed APS and 132 pregnancies from non-APL group. Out of 474, 136 (29%) patients have been treated during pregnancies, and treatment significantly increased the rate of live birth (26% in untreated versus 72% in treated pregnancies, p < 0.0001). In univariate analyses, treatment effect on pregnancy losses was similar in patients with APS and non-conventional APS, with odds ratio at 3.3 (95% CI: 1.8-6.1) and 6.9 (95% CI: 3.9-12.3) (p = 0.49) and significantly more important for the 2 APS groups pooled versus non-APL group [OR at 1.9 (95% CI: 1.1-3.5) for non-APL group versus 53 (95% CI: 3.5-8.1) for APS groups, p = 0.0025]. Conclusion: In this study, 68% of patients with clinical criteria for obstetrical APS seronegative for conventional APL have non-conventional APL These patients have a significant decrement of pregnancy losses if they receive treatment for APS during their pregnancy. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:232 / 237
页数:6
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