抗磷脂抗體特徵，對於台灣紅斑性狼瘡患者的臨床影響

The Impact of Antiphospholipid Antibody Profile on the Clinical Outcomes Associated with Systemic Lupus Erythematosus in Taiwanese Patients

目的：本研究目的為評估抗磷脂抗體特徵對台灣紅斑性狼瘡患者的臨床影響。方法：回顧性研究單一醫學中心99位紅斑性狼瘡患者的抗磷脂抗體特徵。將99位紅斑性狼瘡患者分成多重抗磷脂抗體陽性、單一抗磷脂抗體陽性、抗磷脂抗體陰性等族群，使用卡方檢定與多元羅吉斯回歸模型評估抗磷脂抗體特徵與動靜脈血栓事件、懷孕併發症的相關性。結果：99位紅斑性狼瘡患者可區分為抗磷脂抗體陽性（n = 46）、抗磷脂抗體陰性（n = 53），其中抗磷脂抗體陽性者可再區分為多重抗磷脂抗體陽性（n = 15）、單一抗磷脂抗體陽性（n = 31）。卡方檢定顯示紅斑性狼瘡患者中具有多重抗磷脂抗體陽性者與動靜脈血栓顯著相關(OR 4.19, 95% CI 1.34-13.11, P = 0.021）。納入年齡、性別、抽煙、高血壓等因素進行羅吉斯迴歸分析亦顯示多重抗磷脂抗體陽性與紅斑性狼瘡患者的動靜脈血栓事件顯著相關（OR 5.72. 95% CI 1.59-20.60, P = 0.008）。而單一抗磷脂抗體陽性則並未顯示與紅斑性狼瘡患者的動靜脈血栓事件或懷孕併發症顯著相關。結論：多重抗磷脂抗體陽性與台灣紅斑性狼瘡患者的動靜脈血栓事件顯著相關。

Objectives: The aim of this study was to determine the impact of antiphospholipid (aPL) profile on thrombosis and pregnancy morbidity associated with systemic lupus erythematosus (SLE) in Taiwanese patients. Methods: Ninety-nine out of the 689 patients with SLE who were admitted to the Chang Gung Memorial Hospital between January 2005 and December 2012 and for whom data pertaining to the aPL profile were available were included in this study. The 99 SLE patients were tested for all three aPL antibody tests including lupus anticoagulants (LA), anticardiolipin (aCL) antibodies (IgM and IgG), and anti-beta2-glycoprotein I (anti-β2-GPI) antibodies (IgM and IgG). Results: Of the 99 patients, 46 (46.5%) patients had at least one positive aPL test (including LA, IgM/IgG aCL antibodies, IgM/IgG anti-β2-GPI antibodies), while 53 patients had negative aPL. The 46 aPL-positive SLE patients were further classified into two subgroups: multiple aPL positivity (more than one aPL test positive) (n = 15) and single aPL positivity (LA, aCL antibodies, or anti-β2-GPI antibodies) (n = 31). Multiple aPL positivity was associated with approximately 5.7 times greater risk of venous or arterial thromboembolism [adjusted odds ratio (OR) 5.72. 95% confidence interval (CI) 1.59–20.60, P = 0.008]; however multiple aPL positivity showed no significant association with pregnancy morbidity. Single aPL test positivity was not associated with significantly greater vascular thrombotic risk or pregnancy morbidity. Conclusions: Among Taiwanese patients with SLE, those with more than one positive aPL test showed greater risk of vascular thrombosis.