Anticorpos antifosfolípides em 66 pacientes com infarto cerebral entre 15 e 40 anos

Siqueira Neto, José Ibiapina; Santos, Antonio C.; Fábio, Soraia R. Cabette; Sakamoto, Américo C.

doi:10.1590/S0004-282X1996000400006

Resumos

Os anticorpos antifosfolípides (aFLs) constituem grupo heterogêneo de imunoglobulinas que tem sido relacionado com alterações na coagulabilidade. Indivíduos com títulos elevados teriam maior probabilidade de desenvolver tromboses de repetição, tanto arterial como venosa, e por conseguinte infarto cerebral (IC). Os testes para detecção mais utilizados em estudos clínicos são o inibidor lúpico e a anticardiolipina. Têm-se relatado maiores percentuais de positividade nesses testes em pacientes jovens com IC. Neste estudo procuramos investigar a prevalência desses anticorpos em pacientes com IC entre 15 e 40 anos em nosso Serviço. Examinamos 66 pacientes para presença de aFLs e obtivemos 16,65% de resultados positivos. Confirmamos diagnóstico de síndrome do anticorpo antifosfolípide primária em três (4,55%) casos. Concluímos que a pesquisa de rotina para aFLs em pacientes jovens com IC está indicada neste grupo de pacientes, mas correlacioná-los com o episódio isquêmico nem sempre é possível.

infarto cerebral; anticorpos antifosfolípides; hipercoagulabilidade

The antiphospholipid antibodies (aPLs) are a heterogenous group of immunoglobulins that have been related with alterations in blood coagulability in recent years. Patients with elevated titers of these antibodies have a high probability to develop thrombotic events, including cerebral infarct (CI). The tests currently used to detect these antibodies are the lupus anticoagulant and ELISA for anticardiolipin antibodies which have a larger proportion of positivity among young patients with CI. In our study we tested 66 patients with cerebral infarcts whose ages ranged from 15 to 40 years for the presence of lupus anticoagulant and anticardiolipin antibodies. The results showed that eleven (16.65%) patients were positive for aPLs and three (4.55%) of them fulfilled the diagnostic criteria for primary antiphospholipid syndrome. These data point out to the importance of investigating aPLs in young patients with CI and its high prevalence in this group compared with healthy population.

antiphospholipid antibodies; cerebral infarcts; hypercoagulation states

Anticorpos antifosfolípides em 66 pacientes com infarto cerebral entre 15 e 40 anos

Antiphospholipid antibodies in 66 patients with cerebral infarction between 15 and 40 years old

José Ibiapina Siqueira Neto^I; Antonio C. Santos^II; Soraia R. Cabette Fábio^III; Américo C. Sakamoto^IV

^IM.D., Professor Adjunto Doutor do Departamento de Medicina Clínica da Universidade Federal do Ceará

^IIM.D., Professor Assistente de Neurorradiologia do Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo (USP)

^IIIM.D., Médica Assistente do Departamento de Neurologia, Psiquiatria e Psicologia Médica da FMRP/USP

^IVM.D., Professor Associado do Departamento de Neurologia, Psiquiatria e Psicologia Médica da FMRP/USP

RESUMO

Os anticorpos antifosfolípides (aFLs) constituem grupo heterogêneo de imunoglobulinas que tem sido relacionado com alterações na coagulabilidade. Indivíduos com títulos elevados teriam maior probabilidade de desenvolver tromboses de repetição, tanto arterial como venosa, e por conseguinte infarto cerebral (IC). Os testes para detecção mais utilizados em estudos clínicos são o inibidor lúpico e a anticardiolipina. Têm-se relatado maiores percentuais de positividade nesses testes em pacientes jovens com IC. Neste estudo procuramos investigar a prevalência desses anticorpos em pacientes com IC entre 15 e 40 anos em nosso Serviço. Examinamos 66 pacientes para presença de aFLs e obtivemos 16,65% de resultados positivos. Confirmamos diagnóstico de síndrome do anticorpo antifosfolípide primária em três (4,55%) casos. Concluímos que a pesquisa de rotina para aFLs em pacientes jovens com IC está indicada neste grupo de pacientes, mas correlacioná-los com o episódio isquêmico nem sempre é possível.

Palavras-chave: infarto cerebral, anticorpos antifosfolípides, hipercoagulabilidade.

ABSTRACT

The antiphospholipid antibodies (aPLs) are a heterogenous group of immunoglobulins that have been related with alterations in blood coagulability in recent years. Patients with elevated titers of these antibodies have a high probability to develop thrombotic events, including cerebral infarct (CI). The tests currently used to detect these antibodies are the lupus anticoagulant and ELISA for anticardiolipin antibodies which have a larger proportion of positivity among young patients with CI. In our study we tested 66 patients with cerebral infarcts whose ages ranged from 15 to 40 years for the presence of lupus anticoagulant and anticardiolipin antibodies. The results showed that eleven (16.65%) patients were positive for aPLs and three (4.55%) of them fulfilled the diagnostic criteria for primary antiphospholipid syndrome. These data point out to the importance of investigating aPLs in young patients with CI and its high prevalence in this group compared with healthy population.

Key words: antiphospholipid antibodies, cerebral infarcts, hypercoagulation states.

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Aceite: 13-maio-1996.

Dr. José Ibiapina Siqueira Neto - Av. Historiador Raimundo Girão 444/701 - 60165-050 Fortaleza CE - Brasil.

1. Alarcón-Segovia D, Sanchez-Guerrero J. Primary antiphospholipid syndrome. J Reumatol 1989; 16:482-488.
2. Antiphospholipid Antibodies in Stroke Study Group (APASS). Clinical and laboratory findings in patients with antiphospholipid antibodies and cerebral ischemia. Stroke 1990;21:1268-1273.
3. Antiphospholipid Antibodies in Stroke Study Group (APASS). Clinical, radiological, and pathological aspects of cerebrovascular disease associated with antiphospholipid antibodies. Stroke 1993;24(Suppl.1):1120-1123.
4. Asherson RA, Cervera R. Antiphospholipid syndrome. J Invest Dermatol 1993;100(Suppl.l):S21-S27.
5. Asherson RA, Khamashta MA, Gil A, Vazquez J-J, Chan Q, Baguley E, Hughes GRV. Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome. Am J Med 1989;86:391-399.
6. Babikian VL, Levine SR. Therapeutic considerations for stroke patients with antiphospholipid antibodies. Stroke 1992;23(Suppl I):133-137.
7. Beynon HLC, Walport MJ. Antiphospholipid antibodies and cardiovascular disease. Br Heart J 1992;67:281-284.
8. Brey RL, Gharavi AE, Lockshin MD. Neurologic complications of antiphospholipid antibodies. Rheum Dis Clin North Am 1993;19:833-850.
9. Brey RL, Hart RG, Sherman DG, Tegeler CH. Antiphospholipid antibodies and cerebral ischemia in young people. Neurology 1990;40:1190-1195.
10. Briley DP, Coull BM, Goodnight SH Jr. Neurological disease associated with antiphospholipid antibodies. Ann Neurol 1989;25:221-227.
11. Costa HLFF, De Moura MD, Ferriani RA, Anceschi MIS, Barbosa JE. Prevalence of anti-cardiolipin antiboby in habitual aborters. Gynecol Obstetr Invest 1993;36:221-225.
12. Coull BM, Levine SR, Brey RL. The role of antiphospholipid antibodies in stroke. Neurol Clin 1992;10:125-143.
13. Ferro D, Quintarelli C, Rasura M, Antonini G, Violi F. Lupus anticoagulant and the fibrinolytic system in young patients with stroke. Stroke 1993;24:368-370.
14. Greaves M. Coagulation abnormalities and cerebral infarction. J Neurol Neurosurg Psychiatry 1993;56:433-439.
15. Harris EG, Khamashta MA, Hughes GRV. Antiphospholipid antibody syndrome. In McCarty TJ (ed). Arthritis and allied conditions: a textbook of reumatology. Ed 12. Philadelphia: Lea & Febiger, 1993:1201-1212.
16. Harris EN. Serological detection of antiphospholipid antibodies. Stroke 1992;23(Suppl 1):13-16.
17. Hart RG, Miller VT, Coull BM, Bril V. Cerebral infarction associated with lupus anticoagulants: preliminary report. Stroke 1984;15:114-118.
18. Hess D.C. Stroke associated with antiphospholipid antibodies. Stroke 1992;23(Suppl I): 123-128.
19. Hughes GRV, Harris NN, Gharavi AE. The anticardiolipin syndrome. J Reumathol 1986; 13:486-489.
20. Kalashinikova LA, Nasonov EL, Kushekbaeva AE, Gracheva LA. Anticardiolipin antibodies in Sneddon's syndrome. Neurology 1990;40:464-467.
21. Levine SR, Brey RL, Joseph CLM, Havstad S, on behalf of the Antiphospholipid Antibodies in Stroke Study Group. Risk of recurrent thromboembolic events in patients with focal cerebral ischemia and antiphospholipid antibodies. Stroke 1992;23(Suppl I):129-131
22. Levine SR, Deegan MJ, Futrell N, Welch KMA. Cerebrovascular and neurologic disease associated with antiphospholipid antibodies: 48 cases. Neurology 1990;40:1181-1189.
23. Lockshin MD. Which patients with antiphospholipid antibody should be treated and how? Rheum Dis Gin North Am 1993;19:235-247.
24. Nencini P, Baruffi MC, Abbate R, Massai G, Amaducci L, Inzitari D. Lupus anticoagulant and anticardiolipin antibodies in young adults with cerebral ischemia. Stroke 1992;23:189-193.
25. Sammaritano LR, Gharavi AE, Lockshin MD. Anthiphospholipid antibody syndrome: immunologic and clinical aspects. Semin Arthrit Rheum 1990;20:81 -96.
26. Stockhammer G, Felber SR, Zelger B, Sepp N, Birbamer GG, Fritsch PO, Aichner FT. Sneddon's syndrome: diagnosis by skin biopsy and MRI in 17 patients. Stroke 1993;24:685-690.
27. Tinone G, Scaff M. O papel dos anticorpos antifosfolípides nos acidentes vasculares cerebrais. Neurociências 1994;2:3-7.
28. Tripplet DA. Coagulation assays for the lupus anticoagulant: review and critique of current metodology. Stroke 1992;23(Suppl I):111-14.
29. Zelger B, Sepp N, Schmid KW, Hintner H, Klein G, Fritsch PO. Life history of cutaneous vascular lesions in Sneddon's syndrome. Hum Pathol 1992;23:668-675.

Datas de Publicação

Publicação nesta coleção
12 Nov 2010
Data do Fascículo
Dez 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alarcón-Segovia D, Sanchez-Guerrero J. Primary antiphospholipid syndrome. J Reumatol 1989; 16:482-488.

[2] 2. Antiphospholipid Antibodies in Stroke Study Group (APASS). Clinical and laboratory findings in patients with antiphospholipid antibodies and cerebral ischemia. Stroke 1990;21:1268-1273.

[3] 3. Antiphospholipid Antibodies in Stroke Study Group (APASS). Clinical, radiological, and pathological aspects of cerebrovascular disease associated with antiphospholipid antibodies. Stroke 1993;24(Suppl.1):1120-1123.

[4] 4. Asherson RA, Cervera R. Antiphospholipid syndrome. J Invest Dermatol 1993;100(Suppl.l):S21-S27.

[5] 5. Asherson RA, Khamashta MA, Gil A, Vazquez J-J, Chan Q, Baguley E, Hughes GRV. Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome. Am J Med 1989;86:391-399.

[6] 6. Babikian VL, Levine SR. Therapeutic considerations for stroke patients with antiphospholipid antibodies. Stroke 1992;23(Suppl I):133-137.

[7] 7. Beynon HLC, Walport MJ. Antiphospholipid antibodies and cardiovascular disease. Br Heart J 1992;67:281-284.

[8] 8. Brey RL, Gharavi AE, Lockshin MD. Neurologic complications of antiphospholipid antibodies. Rheum Dis Clin North Am 1993;19:833-850.

[9] 9. Brey RL, Hart RG, Sherman DG, Tegeler CH. Antiphospholipid antibodies and cerebral ischemia in young people. Neurology 1990;40:1190-1195.

[10] 10. Briley DP, Coull BM, Goodnight SH Jr. Neurological disease associated with antiphospholipid antibodies. Ann Neurol 1989;25:221-227.

[11] 11. Costa HLFF, De Moura MD, Ferriani RA, Anceschi MIS, Barbosa JE. Prevalence of anti-cardiolipin antiboby in habitual aborters. Gynecol Obstetr Invest 1993;36:221-225.

[12] 12. Coull BM, Levine SR, Brey RL. The role of antiphospholipid antibodies in stroke. Neurol Clin 1992;10:125-143.

[13] 13. Ferro D, Quintarelli C, Rasura M, Antonini G, Violi F. Lupus anticoagulant and the fibrinolytic system in young patients with stroke. Stroke 1993;24:368-370.

[14] 14. Greaves M. Coagulation abnormalities and cerebral infarction. J Neurol Neurosurg Psychiatry 1993;56:433-439.

[15] 15. Harris EG, Khamashta MA, Hughes GRV. Antiphospholipid antibody syndrome. In McCarty TJ (ed). Arthritis and allied conditions: a textbook of reumatology. Ed 12. Philadelphia: Lea & Febiger, 1993:1201-1212.

[16] 16. Harris EN. Serological detection of antiphospholipid antibodies. Stroke 1992;23(Suppl 1):13-16.

[17] 17. Hart RG, Miller VT, Coull BM, Bril V. Cerebral infarction associated with lupus anticoagulants: preliminary report. Stroke 1984;15:114-118.

[18] 18. Hess D.C. Stroke associated with antiphospholipid antibodies. Stroke 1992;23(Suppl I): 123-128.

[19] 19. Hughes GRV, Harris NN, Gharavi AE. The anticardiolipin syndrome. J Reumathol 1986; 13:486-489.

[20] 20. Kalashinikova LA, Nasonov EL, Kushekbaeva AE, Gracheva LA. Anticardiolipin antibodies in Sneddon's syndrome. Neurology 1990;40:464-467.

[21] 21. Levine SR, Brey RL, Joseph CLM, Havstad S, on behalf of the Antiphospholipid Antibodies in Stroke Study Group. Risk of recurrent thromboembolic events in patients with focal cerebral ischemia and antiphospholipid antibodies. Stroke 1992;23(Suppl I):129-131

[22] 22. Levine SR, Deegan MJ, Futrell N, Welch KMA. Cerebrovascular and neurologic disease associated with antiphospholipid antibodies: 48 cases. Neurology 1990;40:1181-1189.

[23] 23. Lockshin MD. Which patients with antiphospholipid antibody should be treated and how? Rheum Dis Gin North Am 1993;19:235-247.

[24] 24. Nencini P, Baruffi MC, Abbate R, Massai G, Amaducci L, Inzitari D. Lupus anticoagulant and anticardiolipin antibodies in young adults with cerebral ischemia. Stroke 1992;23:189-193.

[25] 25. Sammaritano LR, Gharavi AE, Lockshin MD. Anthiphospholipid antibody syndrome: immunologic and clinical aspects. Semin Arthrit Rheum 1990;20:81 -96.

[26] 26. Stockhammer G, Felber SR, Zelger B, Sepp N, Birbamer GG, Fritsch PO, Aichner FT. Sneddon's syndrome: diagnosis by skin biopsy and MRI in 17 patients. Stroke 1993;24:685-690.

[27] 27. Tinone G, Scaff M. O papel dos anticorpos antifosfolípides nos acidentes vasculares cerebrais. Neurociências 1994;2:3-7.

[28] 28. Tripplet DA. Coagulation assays for the lupus anticoagulant: review and critique of current metodology. Stroke 1992;23(Suppl I):111-14.

[29] 29. Zelger B, Sepp N, Schmid KW, Hintner H, Klein G, Fritsch PO. Life history of cutaneous vascular lesions in Sneddon's syndrome. Hum Pathol 1992;23:668-675.