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

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• 作者：Arsè ; ne Mekinian ; MD^a ; ^{arsene.mekinian@aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Marie-Charlotte Bourrienne ; MD^b ; Lionel Carbillon ; MD ; PhD^c ; Amé ; lie Benbara ; MD^c ; Abisror Noé ; mie ; MD^a ; Sylvie Chollet-Martin ; MD ; PhD^b ; Ahmed Tigaizin ; MD^c ; Francois Montestruc ; MD^d ; Olivier Fain ; MD^a ; Pascale Nicaise-Roland ; MD^b
• 关键词：Antiphospholipid syndrome ; Non-conventional antiphospholipids ; Obstetrical complications ; Pregnancies treatment
• 刊名：Seminars in Arthritis and Rheumatism
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：46
• 期：2
• 页码：232-237
• 全文大小：399 K

文摘

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 5.3 (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.