KLINIČKE MANIFESTACIJE UDRUŽENE SA PRISUSTVOM ANTIFOSFOLIPIDNIH ANTITELA
Manifestacije antifosfolipidnih antitela
Sažetak
Antifosfolipidna antitela (aPL antitela; engl. antiphospholipid antibodies) su heterogena grupa autoantitela koja su usmerena na anjonske fosfolipide ili proteine koji se vezuju za fosfolipide. Mogu biti udružena sa brojnim kliničkim manifestacijama u gotovo svim oblastima medicine, ali je antifosfolipidni sindrom (engl. antiphospholipid syndrome – APS) najpreciznije definisani entitet koji se karakteriše prisustvom ovih antitela. Najčešće kliničke manifestacije prisustva aPL antitela su tromboze, u bilo kom delu cirkulacije, kao i komplikacije trudnoće, u formi spontanog gubitka ploda ili prevremenog porođaja usled preeklampsije, eklampsije ili placentalne insuficijencije. Prema modifikovanoj Sapporo klasifikaciji iz 2006. godine, ove manifestacije predstavljaju jedini klinički kriterijum za dijagnozu APS-a. Međutim, kod približno četvrtine bolesnika sa APS-om, prisutne su i druge patološke promene, koje su često udružene sa aPL antitelima, ali koje ne ulaze u zvanične kriterijume za klasifikaciju ove bolesti. Značajno je da ove manifestacije mogu biti udružene sa aPL antitelima i u odsustvu tromboze ili patologije trudnoće, dakle bez zadovoljenih kriterijuma za APS. Prepoznavanje nekriterijumskih manifestacija je od velikog značaja pošto bi njihov nalaz trebalo da skrene pažnju na moguće prisustvo aPL antitela i ukaže na postojanje APS-a ili na rizik od njegove pojave. Najnovija klasifikacija, objavljena 2023. godine, od strane Američkog koledža za reumatologiju/Evropske alijanse udruženja za reumatologiju (engl. American College of Rheumatology/European Alliance of Associations for Rheumatology – ACR/EULAR), proširila je spisak kliničkih kriterijuma za prepoznavanje antifosfolipidnog sindroma. Ova klasifikacija ima veću specifičnost ali manju senzitivnost u prepoznavanju APS-a u odnosu na ranije kriterijume. Za sada su ACR/EULAR kriterijumi prevashodno namenjeni za odabir bolesnika u kliničkim studijama, a ne za dijagnostikovanje APS-a u svakodnevnoj kliničkoj praksi.
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