ABSTRACT
Objective To explore the correlation of anticardiolipin antibody (ACL) and lupus nephritis (LN) glomerular microthrombi (GMT) in patients with systemic lupus erythematosus (SLE) and to analyze their clinical manifestations and renal pathological characteristics.Methods The clinical data of 126 LN patients treated at our hospital between January 2005 and October 2010 were retrospectively reviewed.The factors,including age,gender,the clinical manifestations in and outside of kidney were evaluated by multivariate Logistic regression analysis.Enzyme-linked immunosorbent assay (ELISA) was used to test the serum levels of ACL in all patients.Statistical analysis was conducted using x2 test and Logistic regression.Results ① All 126 patients were investigated.Thirty-eight LN patients had GMT.When compared with the LN-non-GMT group,the SLE disease activity index (SLEDAI),urinary protein quantity (24 h),serum creatinine,serum urea nitrogen,anti-dsDNA antibody (+),the incidence of severe hypertension,anemia,thrombocytopenia,arthritis were higher in the LN-GMT group (P＜0.01).Logistic regression analysis showed that SLEDAI (OR=2.486,95％CI 1.678-3.684,P=0.000),anemia (OR=4.628,95％CI 1.045～20.496,P=0.044) were correlated with GMT; ② The pathologic results of renal biopsy showed that GMT had an incidence of 30.2％ (n=38) in LN.As compared with the LN-non-GMT group,Wilcoxon test showed that the LN-GMT group suffered more severe greater renal pathological injuries (P=0.012).The pathological types of LN-non-GMT and LN-GMT groups were as follows:type Ⅳ (38％ vs 76％) and type Ⅲ (31％ vs 8％); ③ The positive rate of ACL was higher in the LN-GMT group than that in the LN-non-GMT group (n=23,61％ vs n=15,36％).The differences were statistically significant (P=0.018).Conclusion GMT is not rare in LN.SLEDAI,anemia and positive ACL are correlated with GMT,LN patients with concurrent GMT have more severe renal pathological changes.
ABSTRACT
OBJETIVO: Estudar a prevalência de anticorpos anticardiolipinas em pacientes com úlceras venosas, diabéticas e arteriais e verificar se a contagem de plaquetas, antecedentes obstétricos e de trombose venosa profunda e achados de livedo reticularis ao exame físico servem como marcadores para os casos positivos. MÉTODOS: Estudaram-se 151 pacientes com úlcera de perna (81 com úlceras venosas, 50 com úlceras diabéticas e 20 com úlceras arteriais) e 150 controles. Pesquisou-se, nos dois grupos, a presença de anticorpos anticardiolipina IgG e IgM e contagem de plaquetas. No grupo úlcera foram coletados dados de antecedentes de trombose venosa profunda e de abortamentos e os pacientes foram examinados para presença de livedo reticularis. Os dados obtidos foram agrupados em tabelas de frequência e contingência utilizando-se dos testes de Fisher e qui-quadrado para variáveis nominais e de Mann-Whitney e Kruskall-Wallis para as numéricas. Adotou-se significância de 5 por cento. RESULTADOS: Encontrou-se prevalência de anticorpos anticardiolipina de 7.2 por cento (n=12) no grupo com úlceras e de 1.3 por cento (n=2) no controle (p=0.01). As úlceras de perna anticardiolipinas positivas não diferiram daquelas sem anticardiolipinas quanto ao gênero do paciente (p=0.98) e história de trombose prévia (p=0.69), abortamentos anteriores (p=0.67) e contagens de plaquetas (p=0.67). Só dois pacientes tinham livedo reticularis não permitindo inferências estatísticas a respeito deste dado. CONCLUSÃO: Existe aumento de prevalência de anticorpos anticardiolipinas nos portadores de úlceras de perna em relação à população geral. As características clínicas das úlceras anticardiolipinas positivas e a contagem de plaquetas não auxiliam na identificação desses pacientes.
OBJECTIVE: To study the prevalence of anticardiolipin antibodies in patients with venous, diabetic and arterial leg ulcers and to verify if platelet count, previous history of venous thrombosis, obstetrical history and the finding of livedo reticularis are markers of this autoantibody positivity. METHODS: 151 patients with leg ulcer (81 with venous, 50 with diabetic and 20 with arterial ulcers) and 150 controls were included. In both groups search for the presence of IgG and IgM anticardiolipin and platelet count was done. In the leg ulcer group demographic data, obstetrical history, previous history of venous thrombosis as well as presence of livedo reticularis by physical examination were pointed out. Data was grouped in contingency and frequency tables and the tests of Fisher and chi-squared were used for nominal variables and Mann Whitney and Kruskall Wallis for numerical variables. The adopted significance was of 5 percent. RESULTS: It was found an anticardiolipin prevalence of 7.2 percent (n=12) in the leg ulcer group and of 1.3 percent (n=2) in the control group (p=0.01). Leg ulcer patients with anticardiolipin did not differ from those without it in gender (p=0.98), previous history of venous thrombosis (p=0.69), previous history of abortions (p=0.67) and platelet count (p=0.67). Only two patients had livedo reticularis which precluded any conclusion on this data. CONCLUSION: There is an increased prevalence of anticardiolipin antibodies in the general population with leg ulcers. Clinical characteristics of ulcers as well as platelet count do not help in the identification of these patients.