{"id":10489,"date":"2007-12-14T10:26:09","date_gmt":"2007-12-14T08:26:09","guid":{"rendered":"https:\/\/www.synevo.ro\/afectiuni\/profil-sindrom-antifosfolipidic\/"},"modified":"2020-07-10T13:28:13","modified_gmt":"2020-07-10T10:28:13","slug":"profil-sindrom-antifosfolipidic","status":"publish","type":"synevo_diseases","link":"https:\/\/old.synevo.md\/ru\/afectiuni\/profil-sindrom-antifosfolipidic\/","title":{"rendered":"Profil sindrom antifosfolipidic"},"content":{"rendered":"<p style=\"text-align: justify;\"><span style=\"color: #000080;\"><strong><span style=\"color: #00539f;\">Sindromul antifosfolipidic (APS<\/span>)<\/strong><\/span> descris pentru prima dat\u0103 de Hughes \u00een 1983, este o afec\u0163iune autoimun\u0103 caracterizat\u0103 prin prezen\u0163a anticorpilor antifosfolipidici, trombozelor arteriale \u015fi\/sau venoase \u015fi a pierderilor de sarcin\u0103 repetate. <!--more-->Poate evolua cu acelea\u015fi manifest\u0103ri clinice \u015fi paraclinice ca boala unic\u0103 (sindrom primar) sau asociat altor boli autoimune (sindrom antifosfolipidic secundar). Cea mai frecvent\u0103 asociere este cu lupusul eritematos sistemic, \u00een condi\u0163iile \u00een care jum\u0103tate din pacien\u0163ii cu aceast\u0103 boal\u0103 au anticorpi antifosfolipidici pozitivi \u00een titruri mari. De altfel, prezen\u0163a lor a fost introdus\u0103 recent \u00eentre criteriile de diagnostic ale lupusului la capitolul modific\u0103ri imunologice.<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #00539f;\"><strong>Anticorpii antifosfolipidici<\/strong><\/span> pot s\u0103 apar\u0103 \u015fi \u00een alte boli autoimune, boli infec\u0163ioase (ex. sifilis, infec\u0163ia HIV), post administr\u0103ri medicamentoase sau accidental la 5% din popula\u0163ia s\u0103n\u0103toas\u0103, motiv pentru care anticorpii antifosfolipidici se consider\u0103 c\u0103 au semnifica\u0163ie clinic\u0103 numai \u00een prezen\u0163a sindromului antifosfolipidic.<br>Anticorpii antifosfolipidici cuprind: anticoagulantul lupic (LA), anticorpii anticardiolipidici \u015fi anticorpii anticardiolipidici care recunosc molecule \u201c\u0163int\u0103\u201d specifice (beta2 glicoproteina I, protrombina, proteina C, S, anexina V). Mecanismul exact prin care ace\u015fti anticorpi determin\u0103 apari\u0163ia trombozei nu este cunoscut; c\u00e2teva ipoteze sunt propuse \u2013 activarea plachetelor, activarea celulelor endoteliale \u015fi interac\u0163iunea cu beta2 glicoproteinaI (proteina seric\u0103, care leag\u0103 fosfolipidele anionice de la suprafa\u0163a celulelor endoteliale \u015fi are efect anticoagulant).<\/p>\n<hr>\n<p style=\"text-align: justify;\"><span style=\"color: #00539f;\"><strong>Manifest\u0103rile clinice <\/strong><\/span>ale sindromului cuprind: tromboze venoase \u015fi arteriale recurente \u015fi de obicei cu aceea\u015fi localizare, patologie obstetrical\u0103 (inclus\u0103 \u00eentre criteriile clinice de diagnostic), manifest\u0103ri neurologice (foarte frecvent \u00eent\u00e2lnite \u015fi extrem de variate ex. stroke, atacuri ischemice tranzitorii, neuropatii optice ischemice, pierderea auzului, demen\u0163a, encefalopatia acut\u0103 ischemic\u0103), manifest\u0103ri cardiace (ex. boala coronarian\u0103, valvulopatii mitrale \u015fi aortice, tromboza intracavitar\u0103), cutanate (ex. livedo reticularis, purpura trombotica trombocitopenica, necroze cutanate, gangrene digitale, hemoragii subunghiale), renale (datorate microangiopatiei trombotice, cu simptomatologie asem\u0103n\u0103toare sindromului hemolitic-uremic, dar \u015fi prin infarcte sau tromboze de arter\u0103 renal\u0103), hematologice (ex. trombocitopenia de regul\u0103 moderat\u0103, anemie hemolitic\u0103 autoimun\u0103 cu test Coombs pozitiv).<br>Pacien\u0163ii cu sindrom antifosfolipidic rareori evolueaz\u0103 spre o form\u0103 catastrofic\u0103 a sindromului caracterizat\u0103 prin infarcte multiple de organ, ce determin\u0103 insuficien\u0163a multipl\u0103 de organ \u00een c\u00e2teva zile \u015fi mortalitate crescut\u0103.<\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #00539f;\"><strong>Diagnosticul<\/strong><\/span> sindromului antifosfolipidic conform criteriilor de clasificare revizuite (Eleventh International Congress on aPL, Sydney, Australia, 2004) \u015fi publicate \u00een urma unui consens interna\u0163ional \u00een 2006, se bazeaz\u0103 pe prezen\u0163a a cel pu\u0163in un criteriu clinic \u015fi un criteriu de laborator, ca \u015fi \u00een cazul criteriilor originale de clasificare Sapporo 1998.<br><span style=\"color: #00539f;\"><strong>Criteriile clinice revizuite<\/strong><\/span> au r\u0103mas \u00een mare parte neschimbate \u015fi anume: una\/mai multe tromboze \u00een orice organ ; unul\/mai multe decese ale unui f\u0103t normal morfologic, dup\u0103 10 s\u0103pt\u0103m\u00e2ni de gesta\u0163ie; una\/mai multe na\u015fteri premature ale unui f\u0103t morfologic normal, \u00eenainte de 34 s\u0103pt\u0103m\u00e2ni de gesta\u0163ie; trei\/mai multe avorturi spontane consecutive, \u00eenainte de 10 s\u0103pt\u0103m\u00e2ni de gesta\u0163ie. \u00cen plus, au fost incluse ischemia cerebral\u0103 tranzitorie \u015fi stroke-ul ca forme de tromboz\u0103 vascular\u0103 \u015fi de asemenea, a fost recomandat\u0103 ca fiind deosebit de important\u0103, investigarea coexisten\u0163ei factorilor de risc trombotici ereditari sau dob\u00e2ndi\u0163i la pacien\u0163ii cu APS (factorii tradi\u0163ionali de risc cardiovascular, trombofiliile ereditare, utilizarea de contraceptive orale, interven\u0163iile chirurgicale, neoplaziile, sindromul nefrotic).<\/p>\n<hr>\n<p style=\"text-align: justify;\"><span style=\"color: #00539f;\"><strong>Criteriile de laborator<\/strong><\/span> au fost substan\u0163ial revizuite \u015fi includ: anticorpii anticardiolipina de tip IgG \u015fi\/sau IgM \u00een titruri \u2265 40U la \u2265 2 determin\u0103ri efectuate la cel pu\u0163in 12 s\u0103pt\u0103m\u00e2ni \u015fi anticoagulantul lupic prezent la \u2265 2 determin\u0103ri efectuate la cel pu\u0163in 12 s\u0103ptamani interval. AL se detecteaz\u0103 cu ajutorul testelor de coagulare (aPTT, KCT, dRWT) la care se adaug\u0103 \u201cmixing studies\u201d \u2013 ad\u0103ugarea de plasm\u0103 normal\u0103 (pentru a-l diferen\u0163ia de deficitul de factori) sau ad\u0103ugarea fosfolipidelor \u00een exces (pentru confirmarea prezen\u0163ei AL). \u00cen plus, grupul de consens interna\u0163ional a inclus \u00een cadrul criteriilor revizuite de laborator \u015fi anticorpii anti beta2 glicoproteina I IgG\/IgM.<sup>1,2,3<\/sup><small><\/small><\/p>\n<p><\/p><div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\"><div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\"><p><strong>Analize medicale disponibile \u00een laboratoarele Synevo:<\/strong><\/p><\/div>\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\"><div class=\"synevo-shop-products\">\r\n    <div class=\"sysprod\">\r\n        \r\n        <div class=\"sysprod-products\">\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/anticorpi-anticardiolipinici-igg\/\">Anticorpi anticardiolipinici IgG<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>290 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9157\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9157\"\r\n                                data-product_sku=\"IM66\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/anticoagulant-lupic\/\">Anticoagulant lupic<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>740.00 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9141\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9141\"\r\n                                data-product_sku=\"HE32\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                    <\/div>\r\n        \r\n    <\/div>\r\n<\/div>\r\n\r\n<style>\r\n.synevo-shop-products {\r\n    padding: 24px 0;\r\n    margin: 24px 0;\r\n    border-radius: 10px;\r\n    background: #F6F7F9;\r\n}\r\n.synevo-shop-products .sysprod-product {\r\n    position: relative;\r\n    margin: 0 24px;\r\n    margin-bottom: 24px;\r\n    border-radius: 10px;\r\n    background: #fff;\r\n    display: flex;\r\n    flex-direction: row;\r\n    align-items: center;\r\n}\r\n.synevo-shop-products .sysprod-product:last-child {\r\n    margin-bottom: 0;\r\n}\r\n.synevo-shop-products .sysprod-product-title {\r\n    flex-grow: 1;\r\n    padding: 15px;\r\n    margin-left: 14px;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 16px;\r\n    color: #29263F;\r\n}\r\n.synevo-shop-products .sysprod-product-price {\r\n    flex-shrink: 0;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 18px;\r\n    color: #FDB813;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart {\r\n    flex-shrink: 0;\r\n    position: relative;\r\n    width: 38px;\r\n    height: 38px;\r\n    margin-left: 24px;\r\n    margin-right: 24px;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart .button {\r\n    top: unset;\r\n    right: unset;\r\n}\r\n<\/style><\/div><\/div><p><small><strong>Bibliografie:<\/strong><\/small><\/p><p><small>1. Daniela Opri\u015f, Sindromul antifosfolipidic, www.stetoscop.ro 2004, Ref Type: Internet Communication2. Black, Angelica, Antiphospholipid Syndrome : An Overview, www.findarticles.com 2006, Ref Type: Internet Communication3. Mala Kaul, Doruk Erkan, Lisa Sammaritano, Michael D Lockshin, Assessment of the 2006 revised antiphospholipid syndrome classification criteria, In Annals of the Rheumatic Diseases 2007;66:927-930<\/small><\/p><hr class=\"wp-block-separator\"\/><p>Mai multe informa\u021bii desrep testele disponibile \u00een laboratoarele Synevo:<\/p><p><strong><a href=\"\/shop\/anticorpi-anticardiolipinici-igg\/\" class=\"rank-math-link\">Anticorpi anticardiolipinici IgG<\/a><\/strong><\/p><p><a href=\"\/shop\/anticoagulant-lupic\/\" target=\"_blank\" aria-label=\" (opens in a new tab)\" rel=\"noreferrer noopener\" class=\"rank-math-link\"><strong>Anticoagulant lupic<\/strong><\/a><\/p>","protected":false},"featured_media":0,"template":"","synevo_diseases_category":[897,901],"class_list":["post-10489","synevo_diseases","type-synevo_diseases","status-publish","hentry","synevo_diseases_category-hematologie-si-oncologie","synevo_diseases_category-reumatologie"],"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases\/10489","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/synevo_diseases"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10489"}],"wp:term":[{"taxonomy":"synevo_diseases_category","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases_category?post=10489"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}