背景:高凝状态是COVID-19血栓栓塞事件的危险因素。已经假设涉及抗磷脂(aPL)抗体。典型的COVID-19网状和数字缺血的皮肤病学表现可能类似于抗磷脂综合征(APS)的皮肤表现。
目的:为了研究aPL抗体与血栓栓塞事件之间的关系,COVID-19的严重性,死亡率,COVID-19患者的皮肤表现。
方法:在COVID-19住院患者的冰冻血清样本中滴定aPL抗体[抗β2-糖蛋白-1(B2GP1)和抗心磷脂(aCL)抗体],并对患者的临床记录进行回顾性分析。
结果:纳入173例患者。在34.7%的患者中检测到aPL抗体,抗B2GP1抗体占30.1%,aCL抗体占10.4%。在5.2%的患者中观察到双重阳性。9.8%的患者发生血栓栓塞事件,包括11个肺栓塞,1例腹腔三足血栓形成,和六个影响大脑的动脉缺血事件,乳糜泻,脾,股动脉或主动脉。在52.9%的血管事件患者中发现aPL抗体,但血栓栓塞事件与aPL抗体无关(校正OR=1.69,p=0.502).10例患者(5.8%)有血管病变的皮肤征象:9例网状鱼腥草和1例肢端发青症。在皮肤血管病变和aPL抗体之间没有观察到显著关联(p=0.692)。
结论:抗磷脂抗体不能被认为是COVID-19患者高凝和血栓事件的原因。在COVID-19患者中,网状鱼腥草和肩紫癜似乎不是APS的皮肤表现。
BACKGROUND: Hypercoagulability is a risk factor of thromboembolic events in COVID-19. Anti-phospholipid (aPL) antibodies have been hypothesized to be involved. Typical COVID-19 dermatological manifestations of livedo reticularis and digital ischemia may resemble cutaneous manifestations of anti-phospholipid syndrome (APS).
OBJECTIVE: To investigate the association between aPL antibodies and thromboembolic events, COVID-19 severity, mortality, and cutaneous manifestations in patients with COVID-19.
METHODS: aPL antibodies [anti-beta2-glycoprotein-1 (B2GP1) and anti-cardiolipin (aCL) antibodies] were titered in frozen serum samples from hospitalized COVID-19 patients and the patients\' clinical records were retrospectively analyzed.
RESULTS: 173 patients were enrolled. aPL antibodies were detected in 34.7% of patients, anti-B2GP1 antibodies in 30.1%, and aCL antibodies in 10.4%. Double positivity was observed in 5.2% of patients. Thromboembolic events occurred in 9.8% of patients, including 11 pulmonary embolisms, 1 case of celiac tripod thrombosis, and six arterial ischemic events affecting the cerebral, celiac, splenic, or femoral-popliteal arteries or the aorta. aPL antibodies were found in 52.9% of patients with vascular events, but thromboembolic events were not correlated to aPL antibodies (adjusted OR = 1.69, p = 0.502). Ten patients (5.8%) had cutaneous signs of vasculopathy: nine livedo reticularis and one
acrocyanosis. No significant association was observed between the presence of cutaneous vasculopathy and aPL antibodies (p = 0.692).
CONCLUSIONS: Anti-phospholipid antibodies cannot be considered responsible for hypercoagulability and thrombotic events in COVID-19 patients. In COVID-19 patients, livedo reticularis and
acrocyanosis do not appear to be cutaneous manifestations of APS.