Analiza kardiovaskularnih događaja kod bolesnika sa primarnim i sekundarnim antifosfolipidnim sindromom

Abstract

UVOD: Antifosfolipidni sindrom (AFS) je autoimuno oboljenje koje se odlikuje prisustvom antifosfolipidnih antitela (aFL) i najmanje jednom kliničkom manifestacijom, najčešće trombozom vena i/ili arterija i akušerskom patologijom. Antifosfolipidni sindrom se može javiti u primarnom i sekundarnom obliku. Prisustvo primarnog AFS (PAFS) se definiše ukoliko je odsutna osnovna bolest, dok se sekundarni AFS ispoljava u okviru nekog drugog patološkog stanja, odnosno kada se znaci i simptomi AFS pojavljuju kod bolesnika sa nekom autoimunom bolešću a najčešće u sistemskom eritemskom lupus (SEL). CILJEVI RADA: Ciljevi ove studije bili su da se odredi učestalost kardiovaskularnih događaja (uključujući valvularne promene, trombozu srca, koronarnu bolest, poremećaje ritma i sprovođenja) kod bolesnika sa PAFS i SAFS i izvrši uporedna analiza rezultata između ovih grupa, da se odredi da li postoji korelacija između nivoa antifosfolipidnih antitela (aFL) i pojave određenih kardiovaskularnih događaja i da se ustanovi da li određeni tip aFL ima potencijalni prediktivni značaj za nastanak kardiovaskularnih događaja. MATERIJAL I METODE: Ova kohortna studija obuhvatila je grupu od 101 PAFS i 80 SAFS bolesnika. Svim bolesnicima učinjen je klinički pregled koji je obuhvatio transtorakalni ehokardiografski pregled, određivanje stepena endotelne disfunkcije merenjem vazodilatacije brahijalne arterije izazvane protokom (FMD), ultrazvučni pregled karotidnih arterija u cilju određivanja debljine intime i medije (cIMT) i 24h HOLTER monitoring EKG-a. Svim bolesnicima određeni su laboratorijski pokazatelji AFS-a (antifosfolipidnih antitela - aFL): antikardiolipinska antitela (aKL IgG, IgM klase), anti ß-2 glikoprotein I antitela (anti β2-GPI) (IgG ili IgM klase) i lupus antikoagulans (LA)...

INTRODUCTION: Antiphospholipid syndrome (APS) or Huges Syndrome represents a systemic autoimmune disorder characterized by arterial and/or venous thrombosis, multiple and recurrent fetal losses and elevated levels of antiphospholipid antibodies (aPL), such as lupus anticoagulant (LA), anticardiolipin antibodies (aCL) and anti-ß2GPI antibodies. This syndrome is considered primary (PAPS) if unassociated with any other connective tissue disease or secondary (SAPS) if it appears in association with other autoimmune disorders, mainly systemic lupus erythematosus (SLE) OBJECTIVES: The major objectives of the present study were: 1) to analyze and report the incidence of the various cardiac manifestations in patients with APS comparing PAPS and SAPS groups, 2) to investigate their possible relationship to certain aPL type or level, 3) to establish possible predictive role of aPL for certain manifestations. MATERIAL AND METHODS: This cohort study includes a total of 180 (Caucasians) APS patients; (averaged age 48.69±13.16 years), 159 female (87.8%) i 22 male (12.2%), 101 were PAPS patients and 80 had APS associated with SLE. All patients have undergone complete standard transthoracic echocardiography exam, followed by the endothelial dysfunction estimation by the method of flow dilatation mediated dilatation of brachial artery (FMD), carotid ultrasound with the measurement of intima media thickness (cIMT) and 24 h ambulatory HOLTER ECG monitoring. All patients were evaluated for the presence of aPL: LA, aCL IgG/IgM, anti- ß2GPI IgG/IgM. RESULTS: Prevalence of valvular changes (involving valvular dysfunction and thickness of valvular leaflets) was 26.7% in PAPS and 42.5% in SAPS group (p=0.026). There was no significant relationship between valvular changes and type and level of aPL present...