Valeur relative des différents anticorps antiphospholipides détectés dans un service de médecine interne : étude rétrospective chez 124 patients

Abstract

Purpose. – The value of antiphospholipid antibodies (aPL) detected in the sera of the patients of an Internal Medicine department is not univocal and is still much debated. To test the contribution of such new markers, we reviewed the records of patients having antiphospholipid antibodies detected between 1996 and 1997. Methods. – One hundred and twenty four patients, having at least one of these two aPL : lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or one of these two anti-proteins : anti-β2glycoprotéin I antibodies (anti-β2GPI) or anti-prothrombin antibodies (aPT), were studied. LA was detected by a PTT-LA technique and aCL, anti-β2GPI and aPT by ELISA-sandwich techniques. For each patient we recorded sex, age, personal and familial history of thrombosis, fetal losses and systemic disease, the reason of aPL detection, the final diagnosis, activated partial thromboplastin time (aPTT), platelets count and type of aPL. Results. – The population was composed of 77 women (62%) and 47 men (38%) with a mean age of 54 years 〚12–92 years〛. A thrombocytopenia was strongly correlated to aCL presence (OR = 6,15 et p = 0,03). The reason of aPL detection was venous thrombosis, recurrent fetal losses, systemic disease, infectious disease or fortuitous discovery of a prolonged aPTT. The final diagnosis was a systemic disease in 57% of cases, an infectious disease in 14,5%, a thrombosis in 4,5% and a neoplasia in 3%. LA was detected in 54% of patients, aCL in 39,5%, anti-β2GPI in 23% and aPT in 31%. No relationship between the aPTT value and the type of aPL could be established. Conclusion. – Our study shows that familial histories of venous thrombosis or systemic disease are useful to enhance antiphospholipid antibodies detection ; that LA is mostly associated to systemic and infectious diseases ; that aCL and anti-β2GPI are predominant in case of venous thrombosis and that thrombocytopenia has to enhance aCL detection and the discussion about a possible APS.