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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2020.tde-28102020-165919
Document
Author
Full name
Iana Sousa Nascimento
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2020
Supervisor
Committee
Andrade, Danieli Castro Oliveira de (President)
Borba Neto, Eduardo Ferreira
Lopes, Michelle Remião Ugolini
Signorelli, Flávio Victor
Title in Portuguese
Global antiphospholipid syndrome score e anti-Beta-2-glicoproteína I domínio I na estratificação de risco trombótico da síndrome antifosfolípide: um estudo prospectivo de 4 anos
Keywords in Portuguese
Anti-domínio I
Anticorpos antifosfolipídeos
Autoanticorpos
Autoimunidade
Doenças autoimunes
Síndrome antifosfolipídica
Trombose
Abstract in Portuguese
OBJETIVOS: Avaliar prospectivamente o papel do anticorpo anti-domínio I da Beta-2-glicoproteína I (anti-Domínio I) e do Escore Global da Síndrome Antifosfolípide (do inglês Global Antiphospholipid Syndrome Score) (GAPSS) na identificação de pacientes com síndrome antifosfolípide (SAF) com maior risco de apresentar um novo evento trombótico. MÉTODOS: Pacientes com SAF trombótica foram seguidos no período de maio de 2013 a julho de 2017. À admissão no estudo, foram analisados os anticorpos antifosfolípides anticoagulante lúpico, anticardiolipina, anti-ß2-glicoproteína I e antifosfatidilserina-protrombina (aPS/PT) IgG/IgM e anti-Domínio I IgG e foi calculado o GAPSS de cada paciente. RESULTADOS: 44 pacientes (43 ± 10 anos, 89% sexo feminino, 73% SAF primária) foram seguidos por 39 meses (9- 46). Nesse período, quatro novas tromboses ocorreram, duas delas após interrupção do antagonista da vitamina K. Os dois pacientes com evento recorrente apresentaram GAPSS mais alto (20) e eram triplo positivos e anti- Domínio I-positivos; os demais pacientes tiveram GAPSS mais baixo (mediana 10,5, 0-20) e menor taxa de triplo positivos (33%) e de anti-Domínio I-positivos (38%). anti-Domínio I foi associado com alto GAPSS (mediana 19 vs. 7, p < 0,001; correlação de Pearson 0,82, p < 0,001), tripla positividade (83% vs. 4%, p < 0,001) e com o anticorpo aPS/PT (94% vs. 50%, p=0,002). CONCLUSÃO: Os dados mostram uma correlação significativa entre o escore de risco validado GAPSS e o anticorpo antifosfolípide não critério anti-Domínio I. Futuros estudos são necessários, mas os dados permitem especular um papel do anticorpo anti-Domínio I como uma ferramenta de estratificação de risco de novos eventos trombóticos na SAF
Title in English
Global antiphospholipid syndrome score and anti-Beta-2-glycoprotein I domain for thrombotic risk stratification in antiphospholipid syndrome: a 4-year prospective study
Keywords in English
Anti-Domain I
Antiphospholipid autoantibodies
Antiphospholipid syndrome
Autoantibodies
Autoimmune diseases
Autoimmunity
Thrombosis
Abstract in English
OBJECTIVE: To prospectively assess the role of anti-Beta-2-glycoprotein I domain I antibody (anti-Domain I) 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 anti-Domain I, and calculated GAPSS for each patient. RESULTS: 44 patients (43 ± 10 years, 89% female, 73% primary APS) were followed for 39 months (9-46). Four new thromboses occurred, 2 of them after vitamin K antagonist interruption. Recurrent patients presented higher GAPSS (20) and were triple positive and anti-Domain I positive; non-recurrent patients had lower GAPSS (median 10.5, 0-20) and lower ratio of triple (33%) and anti- Domain I positivities (38%). Anti-Domain I was associated with higher GAPSS (median 19 vs. 7, p < 0.001; Pearson correlation 0.82, p < 0.001) and had higher proportion of triple positivity (83% vs. 4%, p < 0.001) and aPS/PT positivity (94% vs. 50%, p=0.002). CONCLUSION: Our data shows a significant correlation between a validated risk score such as GAPSS and the novel antiphospholipid antibody anti-Domain I. Future studies are needed, however one could speculate a role of anti-Domain I as a risk-stratifying tool for thrombotic events in APS
 
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Publishing Date
2020-10-28
 
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