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1.
Prog. obstet. ginecol. (Ed. impr.) ; 62(4): 394-409, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191428

RESUMO

Antecedentes: el tratamiento de los abortos espontáneos de repetición es controvertido dada la escasez de evidencia disponible al respecto. El objetivo de este trabajo es hacer una revisión sistemática de la literatura acerca del uso de corticoides como terapia de los abortos espontáneos de repetición. Material y métodos: revisión sistemática de la literatura incluyendo 76 artículos clasificados en tres grupos: estudios realizados en pacientes con abortos espontáneos de repetición idiopáticos, abortos espontáneos de repetición asociados a síndrome antifosfolípido y pacientes con fallos de técnicas de fecundación in vitro. Resultados: la revisión de la literatura muestra resultados heterogéneos en cuanto a la contribución de los corticoides en la mejora del desenlace gestacional. Su administración ha demostrado ser beneficiosa en los casos de abortos espontáneos de repetición idiopáticos y posiblemente en aquellos asociados a síndrome antifosfolípido. Los resultados son contradictorios en el caso de las mujeres sometidas a fecundación in vitro, no existiendo metaanálisis concluyentes al respecto. En cuanto a la seguridad, los corticoides han demostrado no producir teratogenicidad. La administración de dosis altas durante largo tiempo se asocia con morbilidad materno-fetal, principalmente crecimiento intrauterino retardado, preeclampsia, diabetes gestacional, hipertensión gestacional, rotura prematura de membranas y parto pretérmino. Sin embargo, el empleo de dosis bajas durante periodos cortos no se ha asociado con efectos adversos maternos ni fetales. Conclusiones: la revisión de la literatura apoya el uso de los corticoides a dosis bajas durante las primeras semanas de embarazo en las pacientes con abortos espontáneos de repetición idiopáticos y posiblemente en los asociados a síndrome antifosfolípido, mientras que su utilidad en pacientes sometidas a técnicas de fecundación in vitro es controvertida


Background: Management of recurrent pregnancy losses is controversial due to the scarcity of literature available. Our aim is to perform a systematic review of the literature about the use of corticoids as therapy for recurrent pregnancy losses. Material and methods: Systematic literature review including 76 papers classified in three groups: idiopathic recurrent pregnancy losses, antiphospholipid syndrome related recurrent pregnancy losses, and patients with failure of in vitro fertilisation. Results: Literature review shows heterogeneous results regarding the effect of corticosteroids in pregnancy outcome. They have been proved to be beneficial in idiopathic recurrent pregnancy losses and possibly in antiphospholipid syndrome related recurrent pregnancy losses. Results are controversial in women undergoing in vitro fertilisation, and conclusive metaanalysis are lacking.Regarding safety, corticosteroids have been shown to be non teratogenic. Long term high dose treatment is associated with maternal and fetal morbitidies, particularly intrauterine growth restriction, preeclampsia, gestational diabetes, gestational hypertension, premature rupture of membranes and premature birth. However, low dose corticosteroids during short periods of time have not been associated with maternal or fetal complications. Conclusions: The literature review supports the use of low dose corticosteroids during the first weeks of pregnancy in patients with idiopathic recurrent pregnancy losses, and possibly in antiphospholipid syndrome related recurrent pregnancy losses. Their efficacy in patients undergoing in vitro fertilisation is controversial


Assuntos
Humanos , Corticosteroides/uso terapêutico , Aborto Espontâneo/tratamento farmacológico , Aborto Habitual/tratamento farmacológico , Síndrome Antifosfolipídica/diagnóstico , Anticorpos Antifosfolipídeos/análise , Aborto Habitual/prevenção & controle
2.
Clin Immunol ; 205: 106-115, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31173887

RESUMO

Recent advances allow us to propose antibodies targeting beta-2-glycoprotein I (ß2-GPI) as the most specific antibodies associated with anti-phospholipid syndrome (APS). Therefore, there is now a crucial need for powerful biological assays to adequately monitor them. It is well established that these antibodies recognize mainly cryptic epitopes, which requires a great deal of consideration in the choice of laboratory tests to identify these antibodies. To this end, an update on the pathophysiological role of ß2-GPI and a meta-analysis were conducted providing an overview of the current progress towards anti-ß2-GPI detection.


Assuntos
Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/imunologia , beta 2-Glicoproteína I/imunologia , Aborto Espontâneo/imunologia , Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica/diagnóstico , Ensaio de Imunoadsorção Enzimática , Humanos , Medições Luminescentes , Trombose/imunologia
3.
Clin Lab ; 65(3)2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30868842

RESUMO

BACKGROUND: Increasing interest has focused on the development of new assays more specific for APS and application of multiple combinations of anti-phospholipid antibodies (aPLs). This study explored the thrombotic risk of non-criteria aPLs measured by a new line immunoassay (LIA) and the benefit of additional non-criteria aPLs results to the APS diagnosis. METHODS: LIA were performed to detect 9 aPLs in 180 patients requested for lupus anticoagulant (LA) measurement. Antibodies against anti-cardiolipin (CL), ß2 glycoprotein I (GPI), and ß2GPI domain I were measured by ELISA. RESULTS: The agreement percentages for IgG/IgM anti-CL and anti-ß2GPI between ELISA and LIA (anti-CL 68.2% and 82.6%; anti-ß2GPI 71.7% and 93.2%, respectively). Among 9 aPLs measured by LIA, single presence IgG of anti-phosphatidylserine (odds ratio (OR) 16.477) and anti-phosphatidic acid (OR 9.625) predicted higher thrombotic risk than anti-ß2GPI (OR 5.538). Other aPLs measured by LIA (anti-prothrombin, anti-annexin V, anti-phosphatidylinositol, phosphatidylethanolamine, and anti-phosphatidylglycerol) did not show any significant thrombotic risk. Addition of the 2 non-criteria aPLs (anti-phosphatidylserine and anti-phosphatidic acid) to the established APS criteria increased the diagnostic specificity and accuracy for thrombosis. The positive rates of anti-ß2GPI and anti-phosphatidylserine measured by LIA were quite high in patients with positive anti-ß2GPI domain I. CONCLUSIONS: The anti-phosphatidylserine and anti-phosphatidic acid among non-criteria aPLs have a high likeli-hood as new markers for thrombotic prediction.


Assuntos
Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica/diagnóstico , Trombose/imunologia , Adulto , Feminino , Humanos , Imunoensaio , Masculino , Ácidos Fosfatídicos/imunologia , Fosfatidilserinas/imunologia , Valor Preditivo dos Testes , beta 2-Glicoproteína I/imunologia
4.
Intern Emerg Med ; 14(4): 521-527, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30603858

RESUMO

How thrombophilia may contribute to the development of chronic thromboembolic pulmonary hypertension (CTEPH) is unknown. We searched on PubMed and EMBASE (until 15 April 2018), studies on CTEPH reporting data on inherited or acquired thrombophilia. Starting from 367 articles mentioning the search terms, 347 were excluded mainly as duplicate articles or articles not in English. After reading the full text of remaining articles, ten were excluded for being reviews, editorials, letters or case reports, and two were further removed from the analysis because of the potential selection bias. All the eight considered studies provided the proportion of patients positive for antiphospholipid (aPL) antibodies. The crude rate of aPL in CTPEH patients is 11.8% (95% CI 10.09-13.8%). The meta-analysis considering the weighted mean proportion and 95% confidence intervals (CIs) yields a rate of aPL antibody-positive profile of 12.06% (95% CI 8.12-16.65%) among the patients with CTEPH in the random effects model (I2 76.33%; 95% CI 52.75-88.14%, p = 0.0001). The sensibility analysis confirms the result. No predictors of heterogeneity are found in a meta-regression analysis. Our results suggest that aPL antibodies are frequently associated with CTEPH underlining the need to test for aPL antibodies in young patients with "idiopathic" and "provoked" PE caused by mild provoking risk factors.


Assuntos
Anticorpos Antifosfolipídeos/análise , Hipertensão Pulmonar/complicações , Prevalência , Trombose/etiologia , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/fisiopatologia , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/fisiopatologia , Fatores de Risco , Trombose/sangue , Trombose/fisiopatologia
5.
Mod Rheumatol ; 29(2): 388-392, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27535710

RESUMO

A 20-year-old man presented with recurrent hemoptysis for seven months. A small subpleural nodule in his right lower lobe was found and excised surgically. Based on the presence of antiphospholipid antibodies (aPL) and vascular wall hypertrophy without vasculitis or an intraluminal thrombus, nonthrombotic proliferative vasculopathy (NTPV) affecting pulmonary arteries was diagnosed. Recently, aPL have been postulated to directly induce the proliferation of vascular cells in the intima and media, leading to NTPV. We review 5 cases of NTPV-associated aPL with critical ischemia in the lower extremities and gastrointestinal infarction. NTPV-associated aPL might be distinct from classic antiphospholipid syndrome and should be considered in aPL-positive patients who present with vascular occlusions of medium-sized vessels in the absence of atherosclerotic risk factors and systemic or local inflammation.


Assuntos
Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica , Hemoptise , Artéria Pulmonar , Túnica Íntima , Túnica Média , Vasculite , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/imunologia , Proliferação de Células , Diagnóstico Diferencial , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Masculino , Artéria Pulmonar/imunologia , Artéria Pulmonar/patologia , Túnica Íntima/patologia , Túnica Íntima/fisiopatologia , Túnica Média/patologia , Túnica Média/fisiopatologia , Vasculite/diagnóstico , Vasculite/etiologia , Vasculite/imunologia , Vasculite/fisiopatologia , Adulto Jovem
8.
Autoimmun Rev ; 17(10): 956-966, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30118899

RESUMO

BACKGROUND: The optimal treatment of women with primary antiphospholipid syndrome (APS) is still debated. About 20-30% of women with APS remain unable to give birth to healthy neonates despite conventional treatment, consisting of prophylactic-dose heparin and low-dose aspirin. These cases are defined "refractory obstetric APS". The early identification of risk factors associated with poor pregnancy outcome could be the optimal strategy to establish criteria for additional therapies, such as hydroxychloroquine, steroids, intravenous immunoglobulin, and plasma exchange. PURPOSE: The aim of the present study was to review current literature about risk factors for poor pregnancy outcome. SEARCH METHODS: The PubMed database was used to search for peer-reviewed original and review articles concerning risk factors for pregnancy outcome in APS from 1st January 1990 to 15th January 2018. OUTCOMES: History of pregnancy morbidity and/or thrombosis, the association with SLE and/or other autoimmune diseases are well known history-based predictive factors for obstetrical complications, such as miscarriage, maternal venous thromboembolism, intrauterine foetal demise, preeclampsia, and neonatal death. Moreover, laboratory findings associated with poor pregnancy outcome are:triple antiphospholipid antibodies aPL positivity, double aPL positivity, single aPL positivity, false-positive IgM for CMV, and hypocomplementemia. Triple positivity is confirmed as the most significant risk factor by a large body of evidence. Furthermore, the abnormal uterine arteries Doppler velocimetry results are confirmed to be strongly associated with poor pregnancy outcomes in APS. The good performance of the uterine arteries velocimetry, as a negative predictive factor, was reported by different studies. On the contrary, in case of abnormal uterine arteries results, the relevance of a careful surveillance is highlighted for the high risk of maternal-foetal complications. Nevertheless, this tool is a late indicator to suggest any additional treatments. CONCLUSIONS: In order to prevent obstetrical complications and establish the optimal combination therapy, the knowledge at preconception or at the beginning of pregnancy of risk factors associated with poor pregnancy outcome could be a crucial step for management and treatment of APS. In addition, in the preconception assessment a regimen with low-dose aspirin, folic acid, and vitamin D supplementation should be offered, and a treatment strategy has to be established (conventional vs additional therapy). In fact, additional treatment has to be tailored for each patient.


Assuntos
Síndrome Antifosfolipídica/terapia , Complicações na Gravidez/terapia , Resultado da Gravidez , Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/imunologia , Síndrome Antifosfolipídica/patologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/patologia , Fatores de Risco
9.
Thromb Res ; 169: 35-40, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30007134

RESUMO

Antiphospholipid Syndrome (APS) is a condition characterized by the occurrence of thromboembolic events and/or pregnancy loss combined with one laboratory criterion among Lupus Anticoagulant- LAC, anticardiolipin -aCL, and anti ß2-Glycoprotein I -aß2GPI antibodies. Several hypotheses were put forward to explain the causal role of antibodies in the clinical events but none is fully convincing. Current laboratory diagnosis is based on three tests (LAC, IgG/IgM aß2GPI and IgG/IgM aCL antibodies). The triple-positive profile (all the three tests positive, same isotype) is associated with a higher risk for thrombosis. The mainstay of therapy in thrombotic APS is anticoagulation, with VKAs being the cornerstone. Low dose aspirin in combination or alone may have a role in arterial thrombosis, and in primary thromboprophylaxis. The Non-Vitamin K Antagonists Oral Anticoagulants (NOACs) role in the therapy of APS is under investigation but not verified. Alternative treatment options including rituximab and eculizumab have been successfully reported in few cases of catastrophic APS.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Trombose/tratamento farmacológico , Trombose/etiologia , Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica/diagnóstico , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/etiologia , Trombose/diagnóstico
10.
Clin Chim Acta ; 485: 74-78, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29953850

RESUMO

BACKGROUND: There seems to be a clear correlation between antibodies against domain I (anti-DI) of ß2Glycoprotein I and severe clinical profiles in antiphospholipid syndrome (APS) patients. We investigated the clinical significance of anti-DI antibodies in a cohort of aPL carriers. METHODS: One hundred and five carriers persistently positive for IgG anti-ß2Glycoprotein 1 antibodies (a-ß2GPI) and/or IgG anticardiolipin (aCL) and/or lupus anticoagulants (LAC) were tested for the presence of anti-DI antibodies using the QUANTA Flash® Beta2GPI-Domain I chemiluminescence immunoassay. RESULTS: Anti-DI antibodies were detected in 44 aPL carriers (41.9%) and they were significantly associated to triple aPL positivity (LAC plus IgG a-ß2GPI plus IgG aCL antibodies). Isolated LAC and a-ß2GPI antibodies were significantly associated to anti-DI negative aPL carriers. During a 82.2 month mean follow-up, ten aPL carriers (9.5%) developed a first thrombotic event so becoming APS patients. Anti-DI antibodies, triple aPL positivity, thromboembolic risk factors and autoimmune disorders significantly prevailed in carriers becoming APS. Logistic regression analysis showed that anti-DI positivity was an independent risk factor for thrombosis. CONCLUSIONS: Anti-DI antibody positivity can be considered a new risk factor predictive of the first thrombotic event in aPL carriers, instead, negative anti-DI may be useful to identify low-risk aPL carriers.


Assuntos
Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/imunologia , beta 2-Glicoproteína I/análise , Adulto , Idoso , Anticorpos Antifosfolipídeos/análise , Estudos de Coortes , Feminino , Humanos , Imunoensaio , Modelos Logísticos , Luminescência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , beta 2-Glicoproteína I/imunologia
11.
J Thromb Thrombolysis ; 46(2): 166-173, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29713925

RESUMO

Antiphospholipid syndrome (APLS) is caused by antiphospholipid autoantibodies, and manifests with vascular and/or obstetric complications. The factors associated with initial disease presentation and course are unknown. We assessed the antibody profile associated with disease presentation and with the development of vascular and obstetric complications in women with initially vascular or initially obstetric APLS. A review of records of APLS women at childbearing age followed at one center during 2006-2015. Of 126 women, median age at diagnosis 29 [23-37] years, 62 were initially diagnosed with purely obstetric APLS and 64 with purely vascular APLS. Baseline characteristics and antibody profile did not differ according to the initial diagnosis. At a mean follow-up duration of 61 ± 23 months, 19 (30.6%) with initially obstetric disease, and 20 (31.3%) with initially vascular disease, developed vascular and obstetric complications, respectively (P = 1.0). Among those with triple positivity [lupus anticoagulant (LAC)+, anticardiolipin (ACL)+, anti beta2-glycoprotein I (AB2GPI)+], a higher proportion developed both obstetric and vascular complications, compared to those with single or double positivity (42.3 vs. 16.4%, P = 0.002). In multivariate analysis, the presence of LAC (P = 0.008), ACL IgG (P = 0.009) or AB2GPI IgG (P = 0.01) was the only independent predictor of the development of both obstetric and vascular complications. Almost one-third of women with initially vascular or initially obstetric APLS developed mixed disease. The antibody profile was the only prognostic marker for disease course. The association found between LAC, ACL IgG or AB2GPI IgG, and patient outcomes could contribute to risk stratification and individualized patient management.


Assuntos
Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica/diagnóstico , Adulto , Síndrome Antifosfolipídica/complicações , Cardiolipinas/imunologia , Feminino , Humanos , Imunoglobulina G/sangue , Inibidor de Coagulação do Lúpus/sangue , Gravidez , Prognóstico , Adulto Jovem , beta 2-Glicoproteína I/imunologia
13.
Nat Rev Dis Primers ; 4: 17103, 2018 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-29321641

RESUMO

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies, such as lupus anticoagulant, anticardiolipin antibodies and anti-ß2-glycoprotein 1 antibodies. APS can present with a variety of clinical phenotypes, including thrombosis in the veins, arteries and microvasculature as well as obstetrical complications. The pathophysiological hallmark is thrombosis, but other factors such as complement activation might be important. Prevention of thrombotic manifestations associated with APS includes lifestyle changes and, in individuals at high risk, low-dose aspirin. Prevention and treatment of thrombotic events are dependent mainly on the use of vitamin K antagonists. Immunosuppression and anticomplement therapy have been used anecdotally but have not been adequately tested. Pregnancy morbidity includes unexplained recurrent early miscarriage, fetal death and late obstetrical manifestation such as pre-eclampsia, premature birth or fetal growth restriction associated with placental insufficiency. Current treatment to prevent obstetrical morbidity is based on low-dose aspirin and/or low-molecular-weight heparin and has improved pregnancy outcomes to achieve successful live birth in >70% of pregnancies. Although hydroxychloroquine and pravastatin might further improve pregnancy outcomes, prospective clinical trials are required to confirm these findings.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Antifosfolipídeos/efeitos adversos , Anticorpos Antifosfolipídeos/análise , Anticorpos Antifosfolipídeos/sangue , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/fisiopatologia , Aspirina/uso terapêutico , Feminino , Humanos , Gravidez , Complicações na Gravidez , Qualidade de Vida , Medição de Risco/métodos , Trombose/etiologia , Trombose/fisiopatologia
14.
Clin Chem Lab Med ; 56(4): 614-624, 2018 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-29166262

RESUMO

BACKGROUND: The aim of the study was to determine the prevalence and clinical associations of antiphosphatidylserine/prothrombin antibodies (aPS/PT) with thrombosis and pregnancy loss in Chinese patients with antiphospholipid syndrome (APS) and seronegative APS (SNAPS). METHODS: One hundred and eighty six Chinese patients with APS (67 primary, 119 secondary), 48 with SNAPS, 176 disease controls (79 systemic lupus erythematosus [SLE], 29 Sjogren's syndrome [SS], 30 ankylosing spondylitis [AS], 38 rheumatoid arthritis [RA]) and 90 healthy donors were examined. IgG and IgM aPS/PT, IgG/IgM/IgA anticardiolipin (aCL) and IgG/IgM/IgA anti-ß2-glycoprotein I (anti-ß2GPI) antibodies were tested by ELISA. RESULTS: One hundred and sixty (86.0%) of APS patients were positive for at least one aPS/PT isotype. One hundred and thirty five (72.6%) were positive for IgG aPS/PT, 124/186 (66.7%) positive for IgM aPS/PT and 99 (53.2%) positive for both. Approximately half of the SNAPS patients were positive for IgG and/or IgM aPS/PT. Highly significant associations between IgG aPS/PT and venous thrombotic events (odds ratio [OR]=6.72) and IgG/IgM aPS/PT and pregnancy loss (OR=9.44) were found. Levels of IgM aPS/PT were significantly different in APS patients with thrombotic manifestations and those with fetal loss (p=0.014). The association between IgG/IgM aPS/PT and lupus anticoagulant (LAC) was highly significant (p<0.001). When both were positive, the OR for APS was 101.6. Notably, 91.95% (80/87) of LAC-positive specimens were positive for IgG and/or IgM aPS/PT, suggesting aPS/PT is an effective option when LAC testing is not available. CONCLUSIONS: Anti-PS/PT antibody assays demonstrated high diagnostic performance for Chinese patients with APS, detected some APS patients negative for criteria markers and may serve as potential risk predictors for venous thrombosis and obstetric complications.


Assuntos
Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica/diagnóstico , Complicações do Trabalho de Parto/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/epidemiologia , Síndrome Antifosfolipídica/imunologia , Biomarcadores/análise , China/epidemiologia , Feminino , Humanos , Masculino , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/imunologia , Fosfatidilserinas/imunologia , Valor Preditivo dos Testes , Gravidez , Protrombina/imunologia , Fatores de Risco , Trombose Venosa/epidemiologia , Trombose Venosa/imunologia
15.
Clin Appl Thromb Hemost ; 24(5): 764-770, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28884611

RESUMO

The activated partial thromboplastin time (APTT) waveform includes several parameters that are related to various underlying diseases. The APTT waveform was examined in various diseases. Regarding the pattern of APTT waveform, a biphasic pattern of the first or second derivative curve (DC) was observed in patients with hemophilia and patients positive for antiphospholipid (aPL) antibodies or coagulation factor VIII (FVIII) inhibitors. The time of the first and second DC and fibrin formation at 1/2 height were prolonged in patients with hemophilia, patients with inhibitors, patients positive for aPL, patients treated with anti-Xa agents, and patients with disseminated intravascular coagulation (DIC). These values all tended to decrease in pregnant women (at 28-36 weeks' gestation). The height of the second derivative peak 1 was significantly lower in patients with hemophilia, patients with FVIII inhibitors, patients positive for aPL, patients treated with anti-Xa agents, and patients with DIC; these values tended to be significantly higher in pregnant women. The height of the first DC was significantly lower in patients who were positive for FVIII inhibitors and was significantly higher in patients treated with anti-Xa agents and pregnant women. The height of the first and second DC was useful for the analysis of hemophilia, FVIII inhibitor, and aPL.


Assuntos
Anticorpos Antifosfolipídeos/análise , Fator VIII/antagonistas & inibidores , Hemofilia A/diagnóstico , Tempo de Tromboplastina Parcial , Coagulação Intravascular Disseminada , Fator VIII/imunologia , Inibidores do Fator Xa/uso terapêutico , Feminino , Fibrina/biossíntese , Humanos , Masculino , Gravidez
16.
J Reprod Immunol ; 123: 78-87, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28985591

RESUMO

Antiphospholipid syndrome (APS) is an autoimmune condition that is associated with thrombosis and morbidity in pregnancy. The exact mechanisms by which these associations occur appear to be heterogeneous and are not yet well understood. The aim of this study was to identify and analyze publications in recent years to better understand the diagnosis and its contribution to monitoring APS among women with recurrent miscarriage (RM). This systematic review and meta-analysis was conducted using the PubMed and Web of Knowledge databases, with articles published between 2010 and 2014, according to the PRISMA statement. Of the 85 identified studies, nine were selected. Most of the studies reported an association between recurrent miscarriage and specific antiphospholipid antibodies, as anticardiolipin antibodies (aCL), lupus anticoagulant (LA), anti-ß2-glycoprotein I antibodies (aß2GPI) and antiphosphatidylserine (aPS), which showed a relationship with RM. The main result of the meta-analysis revealed association between antiphospholipid antibodies (aPLs) and/or APS compared to the patients with RM (OR: 0.279; 95% CI: 0.212-0.366) and APS cases compared to the patients with RM (OR: 0.083; 95% CI: 0.036-0.189). High heterogeneity among these studies (I2=100.0%, p <0.001) was observed. In addition, there was no significant publication bias across studies according to Begg's test (p=0.230), although Egger's test (p=0.037) suggests significant publication bias. The funnel plot was slightly asymmetrical. Systematic review and meta-analysis demonstrated a positive association between antiphospholipid antibodies and/or antiphospholipid syndrome in patients with recurrent miscarriage.


Assuntos
Aborto Habitual/diagnóstico , Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Adulto , Anticorpos Anticardiolipina/análise , Feminino , Humanos , Inibidor de Coagulação do Lúpus/análise , Monitorização Fisiológica , Fosfatidilserinas/imunologia , Gravidez , Viés de Publicação , Padrões de Referência
19.
Presse Med ; 46(7-8 Pt 2): e189-e196, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28803683

RESUMO

Takayasu arteritis (TAK) is a vasculitis of the large arteries. The arterial wall, target of the immune reaction, is composed of vascular dendritic cells, endothelial cells, vascular smooth muscle cells and fibroblasts, which engage in an interaction with T cells and macrophages to, ultimately, cause luminal stenosis or aneurysmal wall damage of the vessel. A multitude of cytokines have been identified to increase in case of TAK and to be linked to disease activity. A better understanding of the physiopathological pathways and mechanisms involved, might enable a more tailored therapeutic approach in TAK.


Assuntos
Arterite de Takayasu/imunologia , Proteínas 14-3-3/metabolismo , Anticorpos/análise , Anticorpos Antifosfolipídeos/análise , Apoptose , Linfócitos B/metabolismo , Diferenciação Celular , Células Endoteliais/imunologia , Proteínas de Choque Térmico/metabolismo , Humanos , Imunidade Inata , Interferon gama/metabolismo , Interleucinas/metabolismo , Mycobacterium tuberculosis , Receptores de Antígenos de Linfócitos T/metabolismo , Células Th17/citologia
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