rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-546-553rsp-3221Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHОбщий индекс антифосфолипидного синдрома (GAPSS) у пациентов с системной красной волчанкойGlobal antiphospholipid syndrome score (GAPSS) in patients with systemic lupus erythematosushttps://orcid.org/0000-0001-5217-4932ЧельдиеваФ. А.CheldievaF. A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-3552-2522РешетнякТ. М.ReshetnyakT. M.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-1318-1894ШумиловаА. А.ShumilovaA. A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-6685-7670НурбаеваК. С.NurbaevaK. S.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-3246-1157ЧеркасоваМ. В.CherkasovaM. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-6068-3080ЛилаА. М.LilaA. M.

115522, Москва, Каширское шоссе, 34а; 125993, Москва, ул. Баррикадная, 2/1, стр. 1

115522, Moscow, Kashirskoye Highway, 34A; 125993, Moscow, Barrikadnaya str., 2/1, building 1

https://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

115522, Москва, Каширское шоссе, 34а; 119991, Москва, ул. Трубецкая, 8, стр. 2

115522, Moscow, Kashirskoye Highway, 34A; 119991, Moscow, Trubetskaya str., 8, building 2

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian FederationRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияV.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)Russian Federation202211112022605546553Copyright © Чельдиева Ф.А., Решетняк Т.М., Шумилова А.А., Нурбаева К.С., Черкасова М.В., Лила А.М., Насонов Е.Л., 20222022Чельдиева Ф.А., Решетняк Т.М., Шумилова А.А., Нурбаева К.С., Черкасова М.В., Лила А.М., Насонов Е.Л.Cheldieva F.A., Reshetnyak T.M., Shumilova A.A., Nurbaeva K.S., Cherkasova M.V., Lila A.M., Nasonov E.L.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3221Введение

Введение. Общий индекс антифосфолипидного синдрома (GAPSS, Global AntiphosPholipid Syndrome Score) – это инструмент, предложенный для количественной оценки риска клинических проявлений, связанных с антифосфолипидными антителами (aФЛ) и некоторыми факторами риска сердечно-сосудистых осложнений.

Цель исследования – сравнить информативность определения высокого риска рецидива тромбозов и/или акушерской патологии с помощью индекса GAPSS в российской когорте пациентов с системной красной волчанкой (СКВ) при использовании пороговых значений GAPSS ≥6 и ≥10.

Материал и методы

Материал и методы. В исследование были включены 115 пациентов. У 50 (44%) из них была СКВ, у 51 (44%) – СКВ с антифосфолипидным синдромом (АФС) и у 14 (12%) – СКВ с антифосфолипидными антителами.

Результаты

Результаты. У 58 из 115 (50%) пациентов в анамнезе были тромбозы, в том числе у 14 (24%) – артериальные, у 29 (50%) – венозные, у 15 (26%) – сочетанные. Беременность на фоне заболевания отмечалась у 43 женщин, включенных в исследование, и у 29 (67%) из них была акушерская патология. У пациентов с тромбозами и акушерской патологией GAPSS составил в среднем 7,17±5,64 балла, при отсутствии этих проявлений – 4,48±4,55 балла (р=0,0003). Отмечена статистически значимая связь между GAPSS и тромбозами: при их наличии GAPSS составил в среднем 7,31±5,70 балла, при отсутствии – 4,00±4,81 балла (р=0,001). При артериальных тромбозах значения GAPPS были выше, чем при венозных (соответственно 10,42±5,30 и 5,82±5,28 балла; р=0,01). Для выбора диапазона значений GAPSS, при котором можно говорить о высоком риске рецидива тромбозов и/или акушерской патологии, была проанализирована симптоматика заболевания у пациентов с GAPSS≥6 и ≥10. В обеих группах отмечалась статистически значимая связь GAPSS с клиническими проявлениями АФС.

Заключение

Заключение. GAPSS≥6 является показателем высокого риска рецидива сосудистых осложнений у больных СКВ.

Introduction

Introduction. The Global Antiphospholipid Syndrome Score (GAPSS) is a tool proposed to quantify the risk of clinical manifestations associated with antiphospholipid antibodies (aPL) and certain cardiovascular risk factors.

Objective

Objective. To validate GAPSS in a cohort of patients with systemic lupus erythematosus in Russia.

Material and methods

Material and methods. 115 patients with SLE were included in the study, including 51 (44%) patients with systemic lupus erythematosus (SLE) with antiphospholipid syndrome (APS), 14 (12%) – SLE with aPL, and 50 (44%) – SLE.

Results

Results. There was a history of thrombosis in 58 (50%) patients with 115, of them 14 (24%) had arterial thrombosis, 29 (50%) – venous, 15 (26%) – combined. Pregnancy against the background of the disease occurred in 43 women included in the study. Of them, 29 (67%) had obstetric pathology. Patients with thrombosis and obstetric pathology had a GAPSS score of 7.17±5.64, versus 4.48±4.55 without these manifestations (p=0.0003). There was a significant association between GAPSS levels and thrombosis – patients with thrombosis had a GAPSS of 7.31±5.70, those without thrombosis – 4.00±4.81 (p=0.001). GAPPS values were higher in arterial thrombosis compared to venous thrombosis (10.40±25.30 versus 5.82±5.28; p=0.01). GAPSS levels ≥6 and ≥10 were analyzed to select GAPSS values at which a high risk of recurrent thrombosis and/or obstetric pathology could be indicated. All GAPSS levels had a significant association with clinical manifestations of APS. The quality of GAPSS by ROC analysis showed an area under the curve (AUC) for GAPSS of 0.697.

Conclusion

Conclusion. GAPSS can be used to assess the risk of recurrence or development of thrombosis and/or obstetric pathology in patients with SLE in the Russian Federation. The GAPSS ≥6 values should be used to stratify patients with SLE into high risk group for recurrence of vascular complications. Further prospective follow-up is needed to confirm the value of GAPSS.

активность заболеванияантифосфолипидный синдромсистемная красная волчанкаантифосфолипидные антителатромбозакушерская патологияdisease activityantiphospholipid syndromesystemic lupus erythematosusantiphospholipid antibodiesthrombosisobstetric pathologyReferencesРешетняк ТМ. Антифосфолипидный синдром: диагностика и клинические проявления (лекция). Научно-практическая ревматология. 2014;52(1):56–71.Reshetnyak TM. Antiphospholipid syndrome: diagnosis and clinical manifestations (a lecture). Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2014;52(1):56–71 (In Russ.).Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295–306. doi: 10.1111/j.1538-7836.2006.01753.xMiyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295–306. doi: 10.1111/j.1538-7836.2006.01753.xRadin M, Ugolini-Lopes MR, Sciascia S, Andrade D. Extra-criteria manifestations of antiphospholipid syndrome: Risk assessment and management. Semin Arthritis Rheum. 2018;48(1):117–120. doi: 10.1016/j.semarthrit.2017.12.006Radin M, Ugolini-Lopes MR, Sciascia S, Andrade D. Extra-criteria manifestations of antiphospholipid syndrome: Risk assessment and management. Semin Arthritis Rheum. 2018;48(1):117–120. doi: 10.1016/j.semarthrit.2017.12.006Alarcon-Segovia D, Pe’rez-Ruiz A, Villa AR. Long-term prognosis of antiphospholipid syndrome in patients with systemic lupus erythematosus. J Autoimmun. 2000;15(2):157–161. doi: 10.1006/ jaut.2000.0402Alarcon-Segovia D, Pe’rez-Ruiz A, Villa AR. Long-term prognosis of antiphospholipid syndrome in patients with systemic lupus erythematosus. J Autoimmun. 2000;15(2):157–161. doi: 10.1006/ jaut.2000.0402Amigo MC. Prognosis in antiphospholipid syndrome. Rheum Dis Clin North Am. 2001;27(3):661–669. doi: 10.1016/s0889- 857x(05)70227-1Amigo MC. Prognosis in antiphospholipid syndrome. Rheum Dis Clin North Am. 2001;27(3):661–669. doi: 10.1016/s0889- 857x(05)70227-1Решетняк ТМ, Чельдиева ФА. Классификационные критерии антифосфолипидного синдрома и его некритериальные проявления. Тромбоз, гемостаз и реология. 2021;(4):4–12.Reshetnyak TM, Cheldieva FA. Classification criteria for antiphospholipid syndrome and its non-criterial manifestations. Tromboz, gemostaz i reologia. 2021;(4):4–12 (In Russ.).Grika EP, Ziakas PD, Zintzaras E, Moutsopoulos HM, Vlachoyiannopoulos PG. Morbidity, mortality, and organ damage in patients with antiphospholipid syndrome. J Rheumatol. 2012;39(3):516–523. doi: 10.3899/jrheum.110800Grika EP, Ziakas PD, Zintzaras E, Moutsopoulos HM, Vlachoyiannopoulos PG. Morbidity, mortality, and organ damage in patients with antiphospholipid syndrome. J Rheumatol. 2012;39(3):516–523. doi: 10.3899/jrheum.110800Ruiz-Irastorza G, Egurbide MV, Ugalde J, Aguirre C. High impact of antiphospholipid syndrome on irreversible organ damage and survival of patients with systemic lupus erythematosus. Arch Intern Med. 2004;164(1):77–82. doi: 10.1001/ archinte.164.1.77Ruiz-Irastorza G, Egurbide MV, Ugalde J, Aguirre C. High impact of antiphospholipid syndrome on irreversible organ damage and survival of patients with systemic lupus erythematosus. Arch Intern Med. 2004;164(1):77–82. doi: 10.1001/ archinte.164.1.77Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. GAPSS: The Global Anti-Phospholipid Syndrome Score. Rheumatology (Oxford). 2013;52(8):1397–1403. doi: 10.1093/rheumatology/kes388Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. GAPSS: The Global Anti-Phospholipid Syndrome Score. Rheumatology (Oxford). 2013;52(8):1397–1403. doi: 10.1093/rheumatology/kes388Sciascia S, Cuadrado MJ, Sanna G, Murru V, Roccatello D, Khamashta MA, et al. Thrombotic risk assessment in systemic lupus erythematosus: Validation of the global antiphospholipid syndrome score in a prospective cohort. Arthritis Care Res (Hoboken). 2014;66(12):1915–1920. doi: 10.1002/acr.22388Sciascia S, Cuadrado MJ, Sanna G, Murru V, Roccatello D, Khamashta MA, et al. Thrombotic risk assessment in systemic lupus erythematosus: Validation of the global antiphospholipid syndrome score in a prospective cohort. Arthritis Care Res (Hoboken). 2014;66(12):1915–1920. doi: 10.1002/acr.22388Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. The global anti-phospholipid syndrome score in primary APS. Rheumatology (Oxford). 2015;54(1):134–138. doi: 10.1093/rheumatology/keu307Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. The global anti-phospholipid syndrome score in primary APS. Rheumatology (Oxford). 2015;54(1):134–138. doi: 10.1093/rheumatology/keu307Oku K, Amengual O, Bohgaki T, Horita T, Yasuda S, Atsumi T. An independent validation of the Global Anti-Phospholipid Syndrome Score in a Japanese cohort of patients with autoimmune diseases. Lupus. 2015;24(7):774–775. doi: 10.1177/0961203314561284Oku K, Amengual O, Bohgaki T, Horita T, Yasuda S, Atsumi T. An independent validation of the Global Anti-Phospholipid Syndrome Score in a Japanese cohort of patients with autoimmune diseases. Lupus. 2015;24(7):774–775. doi: 10.1177/0961203314561284Zuo Y, Li C, Karp DR, Li Z. Clinical and epidemiological correlates of the adjusted global antiphospholipid syndrome score in a large cohort of chinese APS patients. Arthritis Rheumatol. 2015;67(Suppl 10):2183.Zuo Y, Li C, Karp DR, Li Z. Clinical and epidemiological correlates of the adjusted global antiphospholipid syndrome score in a large cohort of chinese APS patients. Arthritis Rheumatol. 2015;67(Suppl 10):2183.Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64(8):2677–2686. doi: 10.1002/art.34473Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64(8):2677–2686. doi: 10.1002/art.34473Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 1992;35(6):630–640. doi: 10.1002/art.1780350606Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 1992;35(6):630–640. doi: 10.1002/art.1780350606Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363–369. doi: 10.1002/art.1780390303Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363–369. doi: 10.1002/art.1780390303Александрова ЕН, Новиков АА, Решетняк ТМ, Клюквина НГ, Решетняк ДВ, Насонов ЕЛ. Антитела к β2-гликопротеину 1 и антитела к кардиолипину при антифосфолипидном синдроме: анализ чувствительности и специфичности. Клиническая медицина. 2003;81(9):25–31.Aleksandrova EN, Novikov AA, Reshetnyak TM, Klykvina NG, Reshetnyak DV, Nasonov EL. Antibodies to beta2-glycoprotein and antibodies to cardiolipin in antiphospholipid syndrome: Analysis of sensitivity and specificity. Clinical Medicine (Russian Journal). 2003;81(9): 25–31 (In Russ.).Реброва ОЮ. Статистический анализ медицинских данных. Применение пакета прикладных программ STATISTICA. М.:МедиаСфера;2002.Rebrova OYu. Statistical analysis of medical data. Application of the application package STATISTICA. Moscow:MediaSfera;2002 (In Russ.).Морозов СП. Клинические испытания программного обеспечения на основе интеллектуальных технологий (лучевая диагностика). Препринт № ЦДТ-2019-1. Лучшие практики лучевой и инструментальной диагностики. М.;2019;23.Morozov SP. Clinical trials of software based on intelligent technologies (radiation diagnostics). Preprint No. CDT-2019-1. Best Practices in Radiation and Instrumental Diagnostics. Moscow;2019;23 (In Russ.).Radin M, Sciascia S, Erkan D, Pengo V, Tektonidou MG, Ugarte A, et al.; APS ACTION. The adjusted global antiphospholipid syndrome score (aGAPSS) and the risk of recurrent thrombosis: Results from the APS ACTION cohort. Semin Arthritis Rheum. 2019;49(3):464–468. doi: 10.1016/j.semarthrit.2019.04.009Radin M, Sciascia S, Erkan D, Pengo V, Tektonidou MG, Ugarte A, et al.; APS ACTION. The adjusted global antiphospholipid syndrome score (aGAPSS) and the risk of recurrent thrombosis: Results from the APS ACTION cohort. Semin Arthritis Rheum. 2019;49(3):464–468. doi: 10.1016/j.semarthrit.2019.04.009Fernandez Mosteirin N, Saez Comet L, Salvador Osuna C, Calvo Villas JM, Velilla Marco J. Independent validation of the adjusted GAPSS: Role of thrombotic risk assessment in the real-life setting. Lupus. 2017;26(12):1328–1332. doi: 10.1177/0961203317703493Fernandez Mosteirin N, Saez Comet L, Salvador Osuna C, Calvo Villas JM, Velilla Marco J. Independent validation of the adjusted GAPSS: Role of thrombotic risk assessment in the real-life setting. Lupus. 2017;26(12):1328–1332. doi: 10.1177/0961203317703493Barinotti A, Radin M, Cecchi I, Foddai SG, Arbrile M, Rubini E, et al. Assessing the cardiovascular risk in patients with systemic lupus erythematosus: QRISK and GAPSS scores headto-head. Int J Cardiol. 2022;363:185–189. doi: 10.1016/ j.ijcard.2022.06.040Barinotti A, Radin M, Cecchi I, Foddai SG, Arbrile M, Rubini E, et al. Assessing the cardiovascular risk in patients with systemic lupus erythematosus: QRISK and GAPSS scores headto-head. Int J Cardiol. 2022;363:185–189. doi: 10.1016/ j.ijcard.2022.06.040Schreiber K, Radin M, Cecchi I, Rubini E, Roccatello D, Jacobsen S, et al. The global antiphospholipid syndrome score in women with systemic lupus erythematosus and adverse pregnancy outcomes. Clin Exp Rheumatol. 2021;39(5):1071–1076. doi: 10.55563/ clinexprheumatol/c96iefSchreiber K, Radin M, Cecchi I, Rubini E, Roccatello D, Jacobsen S, et al. The global antiphospholipid syndrome score in women with systemic lupus erythematosus and adverse pregnancy outcomes. Clin Exp Rheumatol. 2021;39(5):1071–1076. doi: 10.55563/ clinexprheumatol/c96iefDel Barrio-Longarela S, Martínez-Taboada VM, Blanco-Olavarri P, Merino A, Riancho-Zarrabeitia L, Comins-Boo A, et al. Does adjusted Global Antiphospholipid Syndrome Score (aGAPSS) predict the obstetric outcome in antiphospholipid antibody carriers? A single-center study. Clin Rev Allergy Immunol. 2022;63(2):297–310. doi: 10.1007/s12016-021-08915-9Del Barrio-Longarela S, Martínez-Taboada VM, Blanco-Olavarri P, Merino A, Riancho-Zarrabeitia L, Comins-Boo A, et al. Does adjusted Global Antiphospholipid Syndrome Score (aGAPSS) predict the obstetric outcome in antiphospholipid antibody carriers? A single-center study. Clin Rev Allergy Immunol. 2022;63(2):297–310. doi: 10.1007/s12016-021-08915-9Garcia L, Velloso MS, Martire MV, Savy F, Arizpe F, Garcia N, et al. Validation of the adjusted global antiphospholipid syndrome score in systemic lupus erythematosus patients in Argentina. Lupus. 2020;29(14):1866–1872. doi: 10.1177/0961203320960814Garcia L, Velloso MS, Martire MV, Savy F, Arizpe F, Garcia N, et al. Validation of the adjusted global antiphospholipid syndrome score in systemic lupus erythematosus patients in Argentina. Lupus. 2020;29(14):1866–1872. doi: 10.1177/0961203320960814Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 2019;78(10):1296–1304. doi: 10.1136/annrheumdis-2019-215213Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 2019;78(10):1296–1304. doi: 10.1136/annrheumdis-2019-215213

The authors declare that there are no conflicts of interest present.