RESUMO
BACKGROUND: Antiphospholipid syndrome (APS) is characterized by episodes of thrombosis, obstetric morbidity or both, associated with persistently positive antiphospholipid antibodies (aPL). Studying the profile of a rare disease in an admixed population is important as it can provide new insights for understanding an autoimmune disease. In this sense of miscegenation, Brazil is characterized by one of the most heterogeneous populations in the world, which is the result of five centuries of interethnic crosses of people from three continents. The objective of this study was to compare the clinical and laboratory characteristics of Brazilian vs. non-Brazilian primary antiphospholipid syndrome (PAPS) patients. METHODS: We classified PAPS patients into 2 groups: Brazilian PAPS patients (BPAPS) and PAPS patients from other countries (non-BPAPS). They were compared regarding demographic characteristics, criteria and non-criteria APS manifestations, antiphospholipid antibody (aPL) profile, and the adjusted Global Antiphospholipid Syndrome Score (aGAPSS). RESULTS: We included 415 PAPS patients (88 [21%] BPAPS and 327 [79%] non-BPAPS). Brazilian patients were significantly younger, more frequently female, sedentary, obese, non-white, and had a higher frequency of livedo (25% vs. 10%, p < 0.001), cognitive dysfunction (21% vs. 8%, p = 0.001) and seizures (16% vs. 7%, p = 0.007), and a lower frequency of thrombocytopenia (9% vs. 18%, p = 0.037). Additionally, they were more frequently positive for lupus anticoagulant (87.5% vs. 74.6%, p = 0.01), and less frequently positive to anticardiolipin (46.6% vs. 73.7%, p < 0.001) and anti-ß2-glycoprotein-I (13.6% vs. 62.7%, p < 0.001) antibodies. Triple aPL positivity was also less frequent (8% vs. 41.6%, p < 0.001) in Brazilian patients. Median aGAPSS was lower in the Brazilian group (8 vs. 10, p < 0.0001). In the multivariate analysis, BPAPS patients still presented more frequently with livedo, cognitive dysfunction and sedentary lifestyle, and less frequently with thrombocytopenia and triple positivity to aPL. They were also less often white. CONCLUSIONS: Our study suggests a specific profile of PAPS in Brazil with higher frequency of selected non-criteria manifestations and lupus anticoagulant positivity. Lupus anticoagulant (not triple positivity) was the major aPL predictor of a classification criteria event.
Assuntos
Síndrome Antifosfolipídica , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/diagnóstico , Brasil , Técnicas de Laboratório Clínico , Bases de Dados Factuais , Feminino , Humanos , Inibidor de Coagulação do Lúpus/sangue , Masculino , Fatores de RiscoRESUMO
OBJECTIVE: The objective of this study was to identify clinical and laboratory risk factors for ischemic stroke (IS) in primary antiphospholipid syndrome (APS) patients. MATERIALS AND METHODS: We performed a case-control study with consecutive primary APS patients divided into two groups, those who presented with IS, vs. those with no history of stroke. Demographics, vascular risk factors, therapeutic approaches, laboratory, imaging and functional outcomes were recorded. RESULTS: Fifty-three confirmed primary APS patients with IS and sixty-six non-stroke primary APS controls were recruited. Most patients were female (65.5 %), with a median age of 33 years. The main vascular risk factors for primary APS-associated stroke were hypertension (11.3 %), diabetes (11.3 %) and hypercholesterolemia (9.4 %). Among patients with stroke, median NIHSS score was 6; 15.1 % of these patients presented a recurrent stroke, and 88.8 % had a good functional outcome at the final follow-up. Positive lupus anticoagulant (OR = 6.1, 95 %CI 2.7-13.5), anti-ß2 glycoprotein IgG (OR = 3.6, 95 %CI 1.7-7.9), and anticardiolipin IgG (OR = 2.8, 95 %CI 1.3-5.9) were more prevalent in non-stroke primary APS, with a triple-positive antibody presence in 46.4 % of controls vs. 22.2 % of patients with stroke (OR = 3.0, 95 %CI 1.3-6.7). At the time of the index event (arterial or venous), 14 known primary APS patients were using vitamin K antagonists, but only 35.7 % of them had achieved therapeutic INR. CONCLUSION: Patients with primary APS and IS have similar vascular risk factors and lower antibody positivity than those with extracranial thrombosis.
Assuntos
Síndrome Antifosfolipídica/epidemiologia , AVC Isquêmico/epidemiologia , Adulto , Anticorpos Anticardiolipina/imunologia , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/imunologia , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Feminino , Estado Funcional , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Coeficiente Internacional Normatizado , AVC Isquêmico/etiologia , AVC Isquêmico/imunologia , AVC Isquêmico/fisiopatologia , Inibidor de Coagulação do Lúpus/imunologia , Masculino , Isquemia Mesentérica/epidemiologia , Isquemia Mesentérica/etiologia , Oclusão Vascular Mesentérica/epidemiologia , Oclusão Vascular Mesentérica/etiologia , Pessoa de Meia-Idade , Veia Porta , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Fatores de Risco , Trombose Venosa/epidemiologia , Trombose Venosa/etiologiaRESUMO
Abstract Background: Antiphospholipid syndrome (APS) is characterized by episodes of thrombosis, obstetric morbidity or both, associated with persistently positive antiphospholipid antibodies (aPL). Studying the profile of a rare disease in an admixed population is important as it can provide new insights for understanding an autoimmune disease. In this sense of miscegenation, Brazil is characterized by one of the most heterogeneous populations in the world, which is the result of five centuries of interethnic crosses of people from three continents. The objective of this study was to compare the clinical and laboratory characteristics of Brazilian vs. non-Brazilian primary antiphospholipid syndrome (PAPS) patients. Methods: We classified PAPS patients into 2 groups: Brazilian PAPS patients (BPAPS) and PAPS patients from other countries (non-BPAPS). They were compared regarding demographic characteristics, criteria and non-criteria APS manifestations, antiphospholipid antibody (aPL) profile, and the adjusted Global Antiphospholipid Syndrome Score (aGAPSS). Results: We included 415 PAPS patients (88 [21%] BPAPS and 327 [79%] non-BPAPS). Brazilian patients were significantly younger, more frequently female, sedentary, obese, non-white, and had a higher frequency of livedo (25% vs. 10%, p < 0.001), cognitive dysfunction (21% vs. 8%, p = 0.001) and seizures (16% vs. 7%, p = 0.007), and a lower frequency of thrombocytopenia (9% vs. 18%, p = 0.037). Additionally, they were more frequently positive for lupus anticoagulant (87.5% vs. 74.6%, p = 0.01), and less frequently positive to anticardiolipin (46.6% vs. 73.7%, p < 0.001) and anti-ß2-glycoprotein-I (13.6% vs. 62.7%, p < 0.001) antibodies. Triple aPL positivity was also less frequent (8% vs. 41.6%, p < 0.001) in Brazilian patients. Median aGAPSS was lower in the Brazilian group (8 vs. 10, p < 0.0001). In the multivariate analysis, BPAPS patients still presented more frequently with livedo, cognitive dysfunction and sedentary lifestyle, and less frequently with thrombocytopenia and triple positivity to aPL. They were also less often white. Conclusions: Our study suggests a specific profile of PAPS in Brazil with higher frequency of selected non-criteria manifestations and lupus anticoagulant positivity. Lupus anticoagulant (not triple positivity) was the major aPL predictor of a classification criteria event.
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OBJECTIVE: This study aimed to assess prospectively the role of anti-ß2-glycoprotein I domain I antibody (aß2GPI-DI) and the Global Antiphospholipid Syndrome Score (GAPSS) in identifying antiphospholipid syndrome (APS) patients at higher risk of a new event. METHODS: Thrombotic APS patients were followed from May 2013 to July 2017. At baseline, we measured lupus anticoagulant, IgG/IgM anticardiolipin, anti-ß2-glycoprotein I, antiphosphatidylserine-prothrombin (aPS/PT) and IgG aß2GPI-DI, and calculated GAPSS for each patient. RESULTS: A total of 44 patients (age 43 ± 10 years, 89% female, 73% primary APS) were followed for 39 months (range 9-46 months). Four new thromboses occurred, two of them after vitamin K antagonist interruption. Recurrent patients presented higher GAPSS (median 20) and were triple and aß2GPI-DI positive; non-recurrent patients had lower GAPSS (median 10.5, range 0-20) and lower ratio of triple (33%) and aß2GPI-DI positivities (38%). aß2GPI-DI was associated with higher GAPSS (median 19 vs. 7, p < 0.001; Pearson correlation 0.82, p < 0.001) and had a greater proportion of triple (83% vs. 4%, p < 0.001) and aPS/PT positivity (94% vs. 50%, p = 0.002). CONCLUSION: Our data show a significant correlation between a validated risk score such as GAPSS and the novel antiphospholipid antibody aß2GPI-DI. Future studies are needed. However, one could speculate a role of aß2GPI-DI as a risk-stratifying tool for thrombotic events in APS.
Assuntos
Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/complicações , Medição de Risco/métodos , Trombose/imunologia , beta 2-Glicoproteína I/imunologia , Adulto , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fosfatidilserinas/imunologia , Estudos Prospectivos , Protrombina/imunologia , Fatores de Risco , Trombose/etiologiaRESUMO
BACKGROUND: Nontraumatic acute transverse myelitis (ATM) can occur in response to infectious, inflammatory and vascular triggers; 1% of patients with systemic lupus erythematosus (SLE) develop ATM, but the mechanism remains unknown. OBJECTIVE: The objective of this case report is to describe a case of intrathecal formation of anticardiolipin antibodies (aCL) during SLE-related ATM. METHODS: A single patient analysis was conducted. RESULTS: A 26-year-old housewife was diagnosed with SLE at age 19. Circulating aCL antibodies were positive at diagnosis. At age 21, she developed an episode of severe sepsis. At 23 years of age she developed an episode of ATM that left her paraplegic with a D10 sensory level, from which she recovered partially. Three years later, she developed a clinical relapse of ATM. During that second episode, serum levels of aCL were within normal limits, while cerebrospinal fluid levels were increased, suggesting intrathecal production of aCL. CONCLUSION: Here, we present a case of a woman who developed relapsing SLE-related longitudinally extensive ATM in whom intrathecal formation of aCL was demonstrated, suggesting that local production and cross-recognition of nervous tissue by those autoantibodies may be myelopathic.
Assuntos
Anticorpos Anticardiolipina/sangue , Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/diagnóstico , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Recidiva , Medula Espinal/diagnóstico por imagemRESUMO
Conventional treatment of obstetric antiphospholipid syndrome fails in approximately 20-30% of pregnant women without any clearly identified risk factor. It is important to identify risk factors that are associated with these treatment failures. This study aimed to assess the impact of risk factors on pregnancy outcomes in women with obstetric antiphospholipid syndrome treated with conventional treatment. We carefully retrospectively selected 106 pregnancies in women with obstetric antiphospholipid syndrome treated with heparin + aspirin. Pregnancy outcomes were evaluated according to the following associated risk factors: triple positivity profile, double positivity profile, single positivity profile, history of thrombosis, autoimmune disease, more than four pregnancy losses, and high titers of anticardiolipin antibodies and/or anti-ßeta-2-glycoprotein-I (aß2GPI) antibodies. To establish the association between pregnancy outcomes and risk factors, a single binary logistic regressions analysis was performed. Risk factors associated with pregnancy loss with conventional treatment were: the presence of triple positivity (OR = 5.0, CI = 1.4-16.9, p = 0.01), high titers of aß2GPI (OR = 4.4, CI = 1.2-16.1, p = 0.023) and a history of more than four pregnancy losses (OR = 3.5, CI = 1.2-10.0, p = 0.018). The presence of triple positivity was an independent risk factor associated with gestational complications (OR = 4.1, CI = 1.2-13.9, p = 0.02). Our findings reinforce the idea that triple positivity is a categorical risk factor for poor response to conventional treatment.
Assuntos
Anticorpos Anticardiolipina/sangue , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/complicações , beta 2-Glicoproteína I/imunologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/prevenção & controle , Adulto , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/imunologia , Síndrome Antifosfolipídica/terapia , Argentina/epidemiologia , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Doenças Autoimunes/complicações , Feminino , Heparina/administração & dosagem , Heparina/efeitos adversos , Heparina/uso terapêutico , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/imunologia , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco , Trombose/complicações , Falha de TratamentoRESUMO
Antiphospholipid syndrome (APS) is an adquired autoimmune pro-thrombotic disease characterized by arterial and/or venous thrombosis and/or fetal losses associated with the persistent presence of antiphospholipid antibodies (aPL) detectable by solid phase assays (anticardiolipin (aCL) and anti-ß2 glycoprotein I, ß2GPI) and/or functional coagulation test (lupus anticoagulant (LA)). Most patients with typical APS manifestations have the presence of one or more of conventional aPL, but, some patients might exhibit clinical features related with APS but with persistent negative determinations of "classic" aPL (seronegative APS). Expanding the network of autoantibodies in patients highly suspected of having APS but who have normal results from a conventional test using new antibodies (i.e., phosphatidylserine/prothrombin and ß2GPI domain 1) would increase the diagnosis. Thrombosis is one of the leading causes of death among patients with cancer, representing up to 15% of all deaths. Cancer increases the risk of thrombosis and chemotherapy is further associated with a higher risk of thrombosis. In addition, aPL may contribute to an increased risk of thrombosis in patients with malignancies, although the levels do not seem to reflect their pathogenicity. Several malignancies, particularly hematological and lymphoproliferative malignancies, may indeed be associated with the generation of aPL but do not necessarily enhance the thrombophilic risk in these patients.
RESUMO
BACKGROUND: B factor (BF) from the alternative complement pathway seems to participate in the pathophysiology of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). OBJECTIVE: To study the allotypic variability of BF in SLE and their associations with clinical and autoantibodies profile. METHODS: BF allotypes were determined by high-voltage agarose gel electrophoresis, under constant cooling, followed by immunofixation with anti-human BF antibody, in 188 SLE patients and 103 controls. Clinical and serological data were obtained from medical examination and records. RESULTS: No significant differences of BF variants between patients and controls were found, neither in relation to epidemiologic or clinical manifestations. Associations of phenotype BF SS07 and allotype BF*S07 were found with anticardiolipin IgM (aCl-IgM) antibodies (p = 0.014 and p = 0.009 respectively), but not with aCl-IgG, lupus anticoagulant (LA), anti ß2GPI or clinical APS. A significant decrease in BF*F allotype (p = 0.043) and BF SF phenotype (p = 0.018) was detected in patients with anti-phospholipid antibodies as a whole (aCl-IgG, aCl-IgM, LA and anti ß2GPI). CONCLUSIONS: There is a link between phenotype BF SS07 and allotype BF*S07 with aCl-IgM in SLE patients; BF*F allotype could be considered a marker of protection against the development of antiphospholipid antibodies in these patients.
Assuntos
Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/prevenção & controle , Fator B do Complemento/imunologia , Via Alternativa do Complemento , Lúpus Eritematoso Sistêmico/imunologia , Adolescente , Adulto , Idoso , Anticorpos Anticardiolipina/sangue , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/genética , Síndrome Antifosfolipídica/imunologia , Biomarcadores/sangue , Estudos de Casos e Controles , Fator B do Complemento/genética , Eletroforese em Gel de Ágar , Feminino , Frequência do Gene , Humanos , Imunoglobulina M/sangue , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/genética , Masculino , Pessoa de Meia-Idade , Fenótipo , Polimorfismo Genético , Valor Preditivo dos Testes , Fatores de Proteção , Fatores de Risco , Adulto JovemRESUMO
OBJETIVO: Conocer los resultados maternos y perinatales de mujeres con diabetes gestacional diagnosticada según los Criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y la Asociación Latinoamericana de Diabetes. MÉTODOS: Se estudiaron ciento veintidós embarazadas con diagnóstico de diabetes gestacional, aplicando los criterios Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y Asociación Latinoamericana de Diabetes. Se compararon datos socio-demográficos, factores de riesgo para diabetes gestacional, parámetros clínicos y metabólicos durante el embarazo y la pesquisa posparto de diabetes en ambos grupos. Las determinaciones de glucemias de las pruebas de tolerancia oral a la glucosa se realizaron mediante el método enzimático. Se utilizó Chi cuadrado y t de Student para la asociación de variables. Se consideró significativo un valor de P < 0,05. RESULTADOS: Al usar los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo, el número de pacientes con diabetes gestacional aumentó 22,95 %. No hubo diferencias en cuanto a factores de riesgo para diabetes gestacional, resultados maternos y perinatales entre los dos grupos. En el grupo según los criterios Asociación Latinoamericana de Diabetes, las glucemias 2 horas poscarga en el posparto eran más altas (P< 0,02) y resultaron casos de prediabetes. CONCLUSIONES: Se incrementó la proporción de casos con diabetes gestacional, al emplear los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y se detectaron más alteraciones glucémicas maternas en el posparto con los criterios Asociación Latinoamericana de Diabetes. Se requieren investigaciones ulteriores, cuyos resultados puedan contribuir a las decisiones institucionales sobre los criterios para la pesquisa de diabetes gestacional.
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Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Complicações na Gravidez , Gravidez em Diabéticas , Diabetes Gestacional , Saúde Reprodutiva , Hiperglicemia , Fatores de Risco , Morte PerinatalRESUMO
ß2 glycoprotein I (ß2GPI) is a phospholipid binding protein that plays an important role in endothelial stability, blood coagulation, clearance of apoptotic debris and other physiologic processes. Anti-ß2GPI antibodies occur in normal individuals and transiently during the course of infections, but are also associated with thrombotic events in autoimmune disease: the antiphospholipid syndrome (APS). A total of 31 out of 37 treated leprosy patients previously found to present high titers of IgM anti-ß2GPI and/or anticardiolipin antibodies (aCL) remained positive for IgM antiphospholipid antibodies (aPL), and exhibited high titers of anti-ß2GPI. The 37 patients were part of the 77 aPL-positive patients from a previous study that evaluated 158 leprosy patients. The median time elapsed between the first and second sample was 66 months. None of the 37 patients had any thrombotic event and 24 had a reactional state and were still requiring the use of prednisone, thalidomide or both. None of them fulfilled World Health Organization criteria for leprosy recurrence.
Assuntos
Autoanticorpos/sangue , Hanseníase/imunologia , beta 2-Glicoproteína I/imunologia , Adulto , Anticorpos Anticardiolipina/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Doença de Behçet é condição inflamatória e autoimune infrequente, caracterizada por úlceras orais recorrentes e dois ou mais dos seguintesachados ? úlceras genitais, alterações oculares, lesões cutâneas e teste de patergia positivo. A ocorrência de vasculites e de anticorpos antifosfolípides pode contribuir para o aparecimento de tromboembolismos na doença de Behçet. Mulher de 49 anos, com doença de Behçet associada com diagnóstico prévio de síndrome de anticorpos antifosfolípides, apresentou erupção cutânea consistente com a síndrome de Sweet em um local de punção venosa. Foi introduzida prednisona 20mg/dia ao tratamento com warfarina 5 mg/dia que já utilizava, e a resposta satisfatória foi rápida. Pesquisa de sangue oculto foi positiva nas fezes, com concentração de antígeno carcinoembrionário discretamente elevada, e a colonoscopia revelou pólipos no cólon e no sigmoide. O câncerde cólon é descrito em portadores de doença de Behçet com lesões intestinais. Forame oval patente com shunt esquerdo-direito foi achado incidental no presente caso, e essa anomalia propicia embolias paradoxais em pacientes com estados hipercoaguláveis. A associação de doença de Behçet com síndrome de Sweet é raramente descrita e, embora sem o necessário esclarecimento, alguns autores admitem a possibilidade de mecanismo etiopatogênico comum a essas entidades.
Behçet?s disease is an inflammatory and autoimmune condition, characterized by recurrent oral ulcers and, at least, two of the following findings ? genital ulcers, ocular changes, cutaneous lesions, and positivetest for pathergy. The occurrence of vasculitis and antiphospholipid antibodies may contribute to thromboembolisms in Behçet?s disease. A 49-yearold woman with Behçet?s disease associated with a previous diagnosis of antiphospholipid antibodies syndrome presented with an abrupt cutaneous eruption consistent with the Sweet syndrome at the site of venipuncture. Prednisone 20 mg/day was introduced to the treatment with warfarin 5 mg/day that she was undergoing, resulting in a rapid favorable response. Fecal occult blood test was positive, and the level ofcarcinoembryonic antigen was mildly elevated, and the colonoscopy evaluation revealed colon and sigmoid polyps. Colon cancer may develop in patients with intestinal lesions of Behçet?s disease. Patent foramen ovale with left to right shunt was an incidental finding in the present case study, and this anomaly predisposes to paradoxal embolism in patients with thrombophilic conditions. Association between Behçet?s disease andSweet syndrome has been rarely described and, although without the necessary clarification, some authors believe in a possible common etiopathogenic mechanism.
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Objetivo: Describir las características epidemiológicas, clínicas y analíticas de gestantes portadoras del síndrome antifosfolipídico que fueron tratadas en la consulta de medicina interna durante el período 2001-2012. Métodos: Estudio de campo, descriptivo, longitudinal. La población que se estudió fue de 157 pacientes portadoras del síndrome antifosfolipídico, sin tomar en cuenta el criterio del intervalo de al menos 12 semanas para el diagnóstico definitivo. Resultados: Se identificaron como síndrome antifosfolipídico primario 143 pacientes, mientras que como secundario 14 pacientes. Ochenta y seis pacientes solo tuvieron títulos positivos de anticuerpos anticardiolipina, seguido de 62 pacientes con títulos positivos para anticuerpos anticardiolipinas y beta- 2glicoproteína-1, 4 con anticuerpos anticardiolipinas, beta-2glicoproteína-1 y anticoagulante lúpico positivos, 3 solo anticoagulante lúpico positivo y 2 solo beta-2glicoproteína-1 positivo. El tratamiento anticoagulante triple con heparina de bajo peso molecular más ácido acetilsalicílico y prednisona a bajas dosis fue el más frecuentemente utilizado en 99 pacientes. Conclusión: Además de un tratamiento adecuado, el control prenatal y la vigilancia materno-fetal estrecha fue la clave para obtener un resultado favorable en cuanto al bienestar y salud materno-fetal.
Objective: Describe characteristics epidemiological, clinical and analytical for pregnant carrying the antiphospholipid syndrome that were treated in internal medicine, period 2001-2012. Methods: Descriptive, longitudinal, non-experimental and field study. The population that was studied in 157 patients carrying the antiphospholipid syndrome, was not taken into account the criterion interval of at least 12 weeks for definitive diagnosis. Results: We identified 143 patients as primary antiphospholipid syndrome, secondary antiphosphilipid syndrome while as 14 patients. Eighty-six patients had only positive titers of anticardiolipin antibodies, followed 62 patients with positive titers for anticardiolipin antibodies and beta 2 glycoprotein 1, 4 with anticardiolipin antibodies and lupus anticoagulant, beta 2 glycoprotein 1 positive, 3 only lupus anticoagulant positive and 2 beta 2 glycoprotein 1 only positive. The triple anticoagulant therapy with low molecular weight heparin plus acetylsalicylic acid and low-dose prednisone was the most frequently used in 99 patients. Conclusion: In addition to proper treatment, prenatal and maternal-fetal monitoring closely a favorable result was obtained for the welfare and maternal and fetal health.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Bem-Estar Materno , Complicações na Gravidez , Natimorto , Síndrome Antifosfolipídica , Trombose , Trombose Venosa , Fatores de Risco , Monitoramento EpidemiológicoRESUMO
Objetivo: Evaluar los niveles de anticuerpos anticardiolipina en gestantes portadoras del síndrome antifosfolipídico que fueron tratadas en la consulta de medicina interna durante el período 2001-2012. Métodos: Estudio de campo, descriptivo, longitudinal. La población que se estudió fue de 86 pacientes portadoras del síndrome antifosfolipídico. No se tomó en cuenta el criterio del intervalo de al menos 12 semanas para el diagnóstico definitivo. Resultados: En relación con los niveles de IgM e IgG de anticuerpos anticardiolipinas el promedio más alto (30,98) y (19,62) predominó en el primer trimestre del embarazo. El nivel mayor de IgM que se evidenció fue 198, mientras que el menor fue 0,6 durante toda la gestación. Los anticuerpos IgM en el tercer trimestre disminuyeron en 55,81 % con respecto al primer trimestre. Conclusiones: A pesar de que los niveles de anticuerpos son impredecibles, en las últimas etapas de la gestación los anticuerpos anticardiolipinas IgM disminuyeron con respecto a las primeras etapas.
Objective: Evaluate the levels of anticardiolipin antibodies for pregnant carrying the antiphospholipid syndrome that were treated in internal medicine, period 2001-2012. Methods: A descriptive, longitudinal non-experimental and field study. The population studied was 86 patients carrying the SAF, did not take into account the criteria in the interval of at least 12 weeks for definitive diagnosis. Results: In relation to the levels of IgM and IgG anticardiolipin antibodies the highest average (30.98) and (19.62) prevailed in the first trimester of pregnancy. The higher level of IgM was 198, while the lowest was 0.6 during the entire pregnancy. IgM anticardiolipin antibodies in the third quarter decreased by 55.81 % over the first quarter. Conclusions: Although antibody levels are unpredictable, in the latter stages of gestation IgM anticardiolipin antibodies decreased with respect to the early stages.
Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez , Sífilis , Síndrome Antifosfolipídica , Trombose das Artérias Carótidas/complicações , Imunoglobulina MRESUMO
Objetivo: describir la frecuencia de anticuerpos antianexina V en una serie de mujeres que presentaron aborto recurrente en la ciudad de Medellín. Materiales y métodos: se llevó a cabo una serie de casos constituida por mujeres sanas que acudían a consulta ginecológica por historia de pérdidas gestacionales recurrentes caracterizadas por dos o más abortos en el primer trimestre de gestación, en dos instituciones prestadoras de servicios de salud de segundo y tercer nivel de complejidad, y a la consulta privada de algunos ginecólogos de la ciudad de Medellín que aceptaron participar en el estudio. Se excluyeron las mujeres con diagnóstico de síndrome antifosfolípido secundario. Se evaluaron las características sociodemográficas, los antecedentes obstétricos y médicos con énfasis en hipertensión arterial y trombosis. También se evaluaron los anticuerpos anticardiolipina, anticoagulante lúpico, número de anticuerpos antiß2-GPI y número de anticuerpos antianexina V. La información se tabuló en una hoja de cálculo de Microsoft Excel y se procesó en el programa estadístico Stata 10.0, en el análisis estadístico se utilizó estadística descriptiva. Resultados: se encuestaron 65 mujeres con edades entre los 18 y 46 años, la mitad de las pacientes reportaron 2 abortos antes de la décima semana, y la otra mitad después de esta. En los resultados de los anticuerpos anticardiolipina se encontró que el 4,6% (3) de las pacientes presentaron anticuerpos positivos IgM y el 3,1% (2) tenían anticuerpos positivos IgG. El 3,1% (2) de las mujeres presentaron anticuerpos antiß2-GPI IgG e IgM. El 4,6% (3) de las pacientes presentaron anticuerpos positivos antianexina IgG y un 12,3% (8) de estas presentaron un resultado indeterminado.Conclusiones: se evidencia la presencia de anticuerpos antianexina en las pacientes estudiadas, aunque un subgrupo de mujeres presentó un resultado indeterminado; surge la hipótesis de que la anexina V podría ser un factor importante e independiente de los anticuerpos cardiolipina y β2-GPI en las pérdidas gestacionales recurrentes.
Objective: Describing anti-annexin V antibody frequency in a series of females suffering recurrent abortion in Medellin. Materials and methods: A series of cases was compiled, consisting of healthy females attending gynecological consultation who had a background of recurrent pregnancy loss (RPL), characterized by two or more abortions during the first three months of pregnancy. The females were attending a second- and third-level complexity healthcareproviding institution and/or private consultation with some gynecologists in Medellin who agreed to participate in the study. Females diagnosed with secondary antiphospholipid syndrome were excluded. Socio-demographic characteristics, obstetric and medical background emphasizing hypertension and thrombosis were evaluated, as were anti-cardiolipin antibodies, lupus anticoagulant, number of anti-â2-GPI antibodies and number of anti-annexin V antibodies. Such information was tabulated on a Microsoft Excel sheet and processed using Stata 10.0 statistical software; descriptive statistics were used for statistical analysis. Results: 65 females were surveyed, their ages ranging from 18 to 46 years. Half the patients reported 2 abortions before the tenth week and the other half following such time. Anti-cardiolipin antibody results revealed that 4.6% (3) of the patients proved positive for IgM antibodies and 3.1% (2) positive for IgG antibodies. 3.1% (2) of the females had IgG and IgM anti-â2-GPI antibodies. 4.6% (3) of the patients were positive for anti-annexin IgG antibodies and 12.3% (8) had an indeterminate result. Conclusions: Anti-annexin antibodies were detected in the patients surveyed in this study, although a subgroup of females had an indeterminate result. This led to advancing a hypothesis that annexin V could be an important and independent factor for cardiolipin and â2-GPI antibodies in recurrent pregnancy loss.Conclusions: Anti-annexin antibodies were detected in the patients surveyed in this study, although a subgroup of females had an indeterminate result. This led to advancing a hypothesis that annexin V could be an important and independent factor for cardiolipin and β2-GPI antibodies in recurrent pregnancy loss.
Assuntos
Feminino , Gravidez , Aborto Habitual , Anticorpos , Anticorpos AnticardiolipinaRESUMO
OBJECTIVE: The aims of this study were to evaluate the effect of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) on the outcome of the in vitro ferlitization (IVF) cycles and to determine the prevalence of these antibodies in infertile women seeking IVF in Jamaica. METHODS: A retrospective cohort study was performed to determine if screening patients for aCL and LA had any significant impact on the outcome of the IVF process. Each patient's hospital record, between March 2000 and March 2010, was collected and the relevant data extracted. RESULTS: The prevalence of aCL in this cohort of Jamaican women was moderate/high positive 3.88%, low positive 0.68% and those with negative aCL results 95.4%. The prevalence of women who were LA positive was 4.1% and 0.9% of the women were positive for both LA and aCL. Of the patients who were LA and/or aCL positive, eight out of 30 patients (26.7%) had a positive pregnancy test in comparison to 61 out of 181 patients (33.7%) who were LA and/or aCL negative (p = 0.5787). CONCLUSION: The prevalence of positive aCL and/or lA in infertile women seeking IVF in Jamaica is 7.76%. The presence of these antibodies did not affect the pregnancy rate of these women nor did it demonstrate an increased risk for IVF cycle cancellation or ovarian hyperstimulation syndrome. Screening women undergoing IVF for these antibodies is not justified.
OBJETIVO: Los objetivos de este estudio fueron evaluar el efecto del anticuerpo anticardiolipina (aCL) y el anticoagulante lúpico (LA) sobre el resultado de los ciclos de la fertilización en vitro (FIV), así como determinar la prevalencia de estos anticuerpos en mujeres estériles que buscan tratamiento de FIV en Jamaica. MÉTODOS: Se realizó un estudio de cohorte para determinar si el tamizaje de pacientes para detectar el anticuerpo anticardiolipina y el anticoagulante lúpico tenía un impacto significativo en el resultado del proceso de FIV. Se obtuvieron las historias clínicas hospitalarias de cada una de las pacientes, entre marzo de 2000 y marzo de 2010, y se extrajeron los datos pertinentes. RESULTADOS: La prevalencia de aCL en esta cohorte de mujeres jamaicanas fue 3.88% moderada/alta positiva, 0.68% positiva baja, y aquellas con resultados negativos de aCL, 95.4%. La prevalencia de mujeres con resultados de anticoagulante lúpico positivos fue 4.1%, y 0.9% de las mujeres resultaron positivas con respecto tanto al LA como al aCL. De las pacientes que fueron positivas al LA y/o al aCL, ocho de cada 30 pacientes (26.7%) tuvieron una prueba de embarazo positiva, en comparación con 61 de cada 181 pacientes (33.7%) negativas al LA y/o al aCL (p = 0.5787). CONCLUSIÓN: La prevalencia de resultados positivos en relación con anticuerpos anticardiolipinas y/o anticoagulantes lúpicos en mujeres estériles que buscan FIV en Jamaica es 7.76%. La presencia de estos anticuerpos no afectó la tasa de embarazo de estas mujeres, ni mostró un aumento de riesgo de la cancelación del ciclo FIV, o riesgo de síndrome de hiperestimulación ovárica. El tamizaje en busca de estos anticuerpos en mujeres que buscan tratamiento de FIV, no está justificado.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Anticorpos Anticardiolipina/sangue , Infertilidade Feminina/sangue , Inibidor de Coagulação do Lúpus/sangue , Fertilização in vitro , Jamaica , Taxa de Gravidez , Estudos RetrospectivosRESUMO
OBJETIVO: Avaliar a associação entre a presença de anticorpos antinucleossomo (anti-NCS) e a síndrome antifosfolipídica primária (SAFP) e o posterior desenvolvimento de lúpus eritematoso sistêmico (LES). MATERIAIS E MÉTODOS: Trinta e seis mulheres com o diagnóstico de SAFP foram avaliadas prospectivamente para manifestações de doenças reumáticas autoimunes e para a presença de anticorpos antifosfolípides, anticorpos antinucleares e anti-NCS/cromatina. RESULTADOS: Após um período médio de seguimento de 45,7 meses, anticorpos anti-NCS/cromatina foram detectados em apenas uma paciente (2,8%), que desenvolveu manifestações de LES tais como poliartrite, linfopenia, neurite óptica, lesões compatíveis com esclerose múltipla em substância branca cerebral e perfil de autoanticorpos altamente sugestivo de LES. CONCLUSÃO: A frequência de anticorpos anti-NCS/cromatina é baixa em pacientes com SAFP, e sua presença pode associar-se ao desenvolvimento de manifestações de LES.
OBJECTIVE: To study the association of anti-nucleosome (anti-NCS) antibodies in primary antiphospholipid syndrome (APS) and the development of systemic lupus erythematosus (SLE) during follow-up. MATERIALS AND METHODS: Thirty-six women with primary APS were evaluated prospectively for clinical features of systemic autoimmune diseases and for the presence of antiphospholipid antibodies, antinuclear antibodies and anti-NCS/chromatin antibodies. RESULTS: After a mean follow-up period of 45.7 months, anti-NCS/chromatin antibodies were detected in only one patient (2.8%), who developed features of SLE including polyarthritis, lymphopenia, optic neuritis, multiple sclerosis-like lesions, and an autoantibody profile suggestive of SLE. CONCLUSION: The frequency of anti-NCS/chromatin antibodies in primary APS patients is very low, and they may be associated with the development of SLE manifestations.
Assuntos
Adulto , Feminino , Humanos , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/imunologia , Autoanticorpos/sangue , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/imunologia , Nucleossomos/imunologia , Estudos ProspectivosRESUMO
A síndrome do anticorpo antifosfolípide (SAF), mais comum em mulheres, manifesta-se clinicamente como trombose e/ou abortamentos de repetição. Anemia hemolítica autoimune e manifestações neurológicas, cardíacas e cutâneas são comuns. Relata-se o caso de um paciente do gênero masculino cuja manifestação inicial da doença foi gangrena em pavilhão auricular, e o diagnóstico de SAF se deu por meio de biópsia de pele do membro inferior, que mostrava vasculopatia trombótica, sem evidência de vasculite. Esse resultado é um dos dois critérios maiores que, associados a um critério menor, fecham o diagnóstico dessa doença. Discutem-se neste caso os possíveis diagnósticos diferenciais e como eles se diferenciam da doença em foco, além da importância que a biópsia teve no diagnóstico de SAF nesse indivíduo.
Antiphospholipid syndrome (APS), more common in females, manifests clinically as thrombosis and/or recurrent fetal loss. Hemolytic autoimmune anemia and neurological, cardiac and cutaneous manifestations are common. This is the case report of a male patient whose first manifestation of the disease was gangrene of the auricle. The diagnosis of APS was established by biopsy of the lower limb skin, which showed thrombotic vasculopathy with no evidence of vasculitis. This is one of the two major criteria, which, along with a minor criterion, establishes the diagnosis of APS. Possible differential diagnoses are discussed. The importance of the biopsy in the APS diagnosis of this male patient is emphasized.
Assuntos
Adulto , Humanos , Masculino , Síndrome Antifosfolipídica/complicações , Pavilhão Auricular/patologia , Síndrome Antifosfolipídica/diagnóstico , GangrenaRESUMO
AIM: This study aimed at evaluating the prevalence of high anticardiolipin antibody and lupus anticoagulant levels in women with histories of at least two miscarriages. METHODS: The presence of high anticardiolipin antibody and lupus anticoagulant levels were evaluated in 52 patients with ages between 17 and 41 (mean 26.7 years old) who had histories of repeated miscarriages. RESULTS: High anticardiolipin antibody levels were identified in 55.77% and lupus anticoagulant levels in 2% of the individuals. CONCLUSION: In conclusion, women who suffer from repeated miscarriages present with a high prevalence of anticardiolipin antibodies. Further studies on this issue are crucial as these antibodies are associated with hypercoagulability and thus increased the risk of thromboembolic events.
RESUMO
Introdução: Complicações tromboembólicas são importantes fatores de risco para perda do enxerto e pior evolução após o transplante renal. pacientes com defeito trombofílico apresentam maior risco de complicações tromboembólicas. Foram analisados, entre receptores de transplante renal, a prevalência de defeito trombofílico e o risco atribuído a esta condição para a perda do enxerto e para o desenvolvimento de tromboses intravasculares. Métodos: estudo do tipo coorte incluindo 388 receptores adultos analisados quanto à presença de trombofilia de acordo com a pesquisa de anticorpos anticardiolipidina (aCL) por ELISA e das mutações G1691A no gene do fator V (FV) e G20210A no gene da protrombina (PT) por PCR multiplex. Resultados: Defeito trombofílico foi identificado em 25,8% dos pacientes. As taxas de sobrevida de 2 anos do enxerto foram semelhantes entre os pacientes com e sem defeito trombofílico (94%, p=0,53), bem como a sobrevida dos enxertos livres de tromboses intravasculares (97% versus 97%, p=0,83). pacientes com defeito trombofílico apresentaram prevalência de tromboses intravasculares semelhante à do grupo-controle (3% versus 3,5%, p=0,82). O transplante renal anterior foi associado a maior risco de perda de enxerto (OR 20,8, p<0,001) e de ocorrência de trombose intravasculares (OR 6,8, p=0,008). Conclusões: As prevalências das mutações FVG1691A e PTG20210A na população estudada foram semelhantes às da população geral não transplantada, e a prevalência de anticorpos aCL superou a observada entre os indivíduos sadios. Não houve associação entre os marcadores de trombofilia estudados e a sobrevida em médio prazo do transplante renal.
Introduction: Thromboembolic complications are important risk factors for graft loss and poor outcome after renal transplantation. patients with thrombophilic defects are at increased risk of thromboembolic complications. Were analyzed, among kidney transplant recipients, the prevalence of thrombophilic defects and the risk attributed to this condition for graft loss and the development of intravascular thrombosis. Methods: A cohort study including 388 adult recipients analyzed for the presence of thrombophilia according to anticardiolipidina antibodies (aCL) by ELISA and gene mutations G1691A in factor V (FV) and prothrombin gene G20210A (PT) by multiplex PCR. Results: thrombophilic defect was identified in 25.8% of patients. The survival rates of two years of the graft were similar between patients with and without thrombophilic defect (94%, p = 0.53), and the survival of free grafts of intravascular thrombosis (97% versus 97%, p = 0 , 83). patients with an increased prevalence of thrombophilic defect intravascular thrombosis similar to the control group (3% versus 3.5%, p = 0.82). Previous renal transplantation was associated with increased risk of graft loss (OR 20.8, p <0.001) and intravascular thrombosis (OR 6.8, p = 0.008). Conclusions: The prevalence of mutations and FVG1691A PTG20210A in this study were similar to those of the general population not transplanted, and the prevalence of aCL antibodies exceeded that observed among healthy individuals. There was no association between markers of thrombophilia studied and medium-term survival in renal transplantation.
Assuntos
Humanos , Masculino , Feminino , Adulto , Anticorpos Anticardiolipina/análise , Anticorpos Anticardiolipina/genética , Fator V/genética , Modelos Logísticos , Análise de Sobrevida , Trombofilia/complicações , Trombofilia/diagnóstico , Trombofilia/patologia , Transplante de RimRESUMO
OBJETIVOS: Determinar a frequência do fator reumatoide (FR-IgM), anticorpos antipeptídeos citrulinados cíclicos (anti-CCP), antinucleares (AAN), anticitoplasma de neutrófilos (ANCA), anticardiolipina (aCL) e anti-β2 glicoproteína I (anti-β2GPI) em pacientes com hanseníase, com e sem comprometimento articular, avaliando a possível associação entre estes autoanticorpos e as manifestações articulares, a forma clínica, a reação hansênica, o tratamento com poliquimioterapia (PQT) e a alta. PACIENTES E MÉTODOS: 158 pacientes com hanseníase foram distribuídos em dois grupos; 73 pacientes com (Grupo I) e 82 sem comprometimento articular (Grupo II). Compuseram o Grupo III 129 indivíduos saudáveis. MÉTODOS: aglutinação com partículas de látex para FR-IgM, imunofluorescência indireta para AAN e ANCA, e, ELISA para anti-CCP, aCL e anti-β2GPI. RESULTADOS: Dentre 158 pacientes com hanseníase, 56 apresentavam a forma virchowiana (VV). A frequência de anticorpos anti-CCP, FR e AAN nos Grupos I e II foi semelhante à do Grupo III. ANCA não foi detectado em nenhum dos grupos. Anticorpos aCL foram mais frequentes nos pacientes com hanseníase (Grupos I e II) que em controles sadios (15,8 por cento vs. 3,1 por cento; P < 0,001), não sendo observada diferença entre Grupos I e II (P = 0,67). Anticorpos anti-β2GPI também foram mais frequentes nos pacientes que nos controles (46,2 por cento vs. 9,4; P < 0,001), sem diferença significativa entre os Grupos I e II. Houve predomínio do isotipo IgM com relação ao IgG tanto para aCL (88 por cento vs. 16 por cento, P = 0,001), quanto para anti-β2GPI (97,3 por cento vs. 12,3 por cento, P < 0,001). Nenhum paciente apresentou manifestações sugestivas de trombose vascular. CONCLUSÃO: A frequência de anticorpos aCL e anti-β2GPI foi significativamente maior nos pacientes com hanseníase que nos controles saudáveis. Entretanto, a positividade dos demais autoanticorpos foi semelhante à dos controles. Não foi observada associação entre autoanticorpos...
OBJECTIVE: Determine the frequency of rheumatoid factor (IgM-RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP), antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA), anticardiolipin antibodies (aCL), and anti-β2 glycoprotein I antibodies (anti-β2GPI) in leprosy patients, with and without joint involvement, and to evaluate the possible association among those antibodies and articular manifestations, clinical type, reactional episodes, polychemotherapic treatment (PCT), and discharge from PCT. PATIENTS AND METHODS: One hundred and fifty-eight leprosy patients were divided in two groups of 73 patients (Group I) and 82 patients (Group II). Group III was composed of 129 healthy individuals. Methods: Semi-quantitative latex agglutination test for IgM-RF, indirect immunofluorescence for ANA and ANCA, and ELISA for anti-CCP, aCL, and anti-β2GPI. RESULTS: Fifty-six (35.4 percent) of 158 leprosy patients had lepromatous leprosy (LL). The frequency of anti-CCP, RF, and ANA antibodies in Groups I and II was similar to that of Group III. Antineutrophil cytoplasmic antibodies were not detected in any patient. Anticardiolipin antibodies were more frequent in leprosy patients (Groups I and II) than in control group (15.8 percent vs. 3.1 percent; P < 0.001), and differences between Groups I and II (P = 0.67) were not observed. Anti-β2GPI antibodies were also more common in leprosy patients than in control group (46.2 percent vs. 9.4 percent; P < 0.001), without differences between Groups I and II. A predominance of IgM isotype over IgG isotype was observed both for aCL (88 percent vs. 16 percent; P = 0.001) and anti-β2GPI (97.3 percent vs. 12.3 percent; P < 0.001). Patients did not present manifestations suggestive of vascular thrombosis. CONCLUSION: The frequency of aCL and anti-β2GPI antibodies was significantly increased in leprosy patients than in healthy individuals. However, positivity to other autoantibodies...