Proposition de nouveaux critères cliniques et biologiques dans l'évaluation du risque thrombotique des patients atteints de syndrome des antiphospholipides

Abstract : Antiphospholipid syndrome (APS) is characterized by an auto-immune disorder with thrombotic and obstetrical morbidity in the presence of persistant antiphospholipid antibodies (aPL). This work studied clinical manifestations and laboratory assays for the determination of thrombotic risk in APS patients. Firstly, the risk of heart valve disease associated with aPL in systemic lupus erythematosus (SLE) patients was studied. Since 20 years, data regarding this association yielded conflicting results. A systematic review and a meta-analysis were performed to compare frequencies of heart valve disease in SLE patients with and without aPL. Main result concluded that the presence of aPL in SLE patients is associated with a 3-fold increased risk for heart valve disease in comparison with SLE patients without these antibodies. Secondly, prognostic significance of superficial vein thrombosis (SVT) was studied in APS patients. A prospective cohort study was performed and showed that SVT was predictive of thrombotic events overtime in this population. Moreover, the contribution of new laboratory assays were studied (antibodies directed against the domain I of [beta]2-Glycoprotein I and thrombin generation assay assessing sensitivity to activated protein C). Results demonstrated that these two assays were predictive of thrombotic events in APS patients. Finally, health-related quality of life was assessed in a multicentric cohort study of patients with aPL and/or SLE. Results showed that the presence of a history of arterial thrombosis was significantly associated with an impairment of all dimensions scores assessed by the MOS-SF36 questionnaire in comparison with patients with an auto-immune disease but without arterial thrombosis. This work provides new insights in the field of APS and may have an impact in the evolution leading to new classification criteria for definite APS.
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Theses
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http://docnum.univ-lorraine.fr/prive/DDOC_T_2014_0064_ZUILY.pdf
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https://hal.univ-lorraine.fr/tel-01750772
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Submitted on : Thursday, March 29, 2018 - 12:54:32 PM
Last modification on : Friday, March 30, 2018 - 1:32:27 AM

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Stéphane Zuily. Proposition de nouveaux critères cliniques et biologiques dans l'évaluation du risque thrombotique des patients atteints de syndrome des antiphospholipides. Médecine humaine et pathologie. Université de Lorraine, 2014. Français. ⟨NNT : 2014LORR0064⟩. ⟨tel-01750772⟩

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