Prevalencia de anticuerpos anticardiolipina dependientes de beta-2 glicoproteína I en mujeres preeclampticas y normotensas
Abstract
Contexto: Estudios internacionales han reportado una asociación directa de los niveles de anticuerpos anticardiolipina dependientes de beta-2 glicoproteina I (ß2GP-I) con el desarrollo de preeclampsia, pero la evidencia aún es controversial.
Objetivo: Comparar la prevalencia de anticuerpos anticardiolipina dependientes de ß2GP-I entre pacientes ecuatorianas con preeclampsia y embarazo normal.
Diseño: Estudio transversal.
Lugar y sujetos: 80 pacientes con preeclampsia y 80 gestantes normotensas atendidas consecutivamente en la emergencia del Hospital Gineco-Obstétrico Isidro Ayora (HGOIA) de la ciudad de Quito.
Mediciones principales: Detección de anticuerpos anticardiolipina dependientes de ß2GP-I, mediante ensayo enzimático inmunológico (Anti-Cardiolipin Screen®), considerando un valor de corte de 10 U/mL como positivo.
Resultados: La prevalencia de anticuerpos anticardiolipina dependientes de ß2GP-I no fue estadísticamente diferente entre las pacientes con preeclampsia y las gestantes normotensas (15.0% vs. 23.7%; p=ns). Tampoco se encontraron diferencias entre los subgrupos de pacientes con preeclampsia leve y severa (12.8% vs. 18.2%; p=ns). La presencia de un cuadro de preeclampsia no se asoció significativamente con niveles elevados de anticuerpos anticardiolipina dependientes de ß2GP-I (OR=0.57; IC95%= 0.24 - 1.35).
Conclusiones: En gestantes de nuestro país no se encontró una relación entre niveles elevados de anticuerpos anticardiolipina dependientes de ß2GP-I y preeclampsia. La prevalencia de estos anticuerpos en gestantes normotensas fue mayor que la reportada en otras poblaciones.
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2. Aagaard-Tillery KM, Belfort MA. Eclampsia: morbility, mortality, and management. Clin Obstet Gynecol 2005; 48: 12–23.
3. VanWijk MJ, Kublickiene K, Boer K, VanBavel E. Vascular function in preeclampsia. Cardiovasc Res 2000; 47: 38-48.
4. Yasuda M, Takakuwa K, Tokunaga A, Tanaka K. Prospective studies of the association between anticardiolipin antibody and outcome of pregnancy. Obstet Gynecol 1995; 86: 555-59.
5. Branch DW, Andres R, Digre KB, Rote NS, Scott JR. The association of antiphospholipid antibodies with severe preeclampsia. Obstet Gynecol 1989; 73: 541-45.
6. Lynch A, Byers T, Emlen W, Rynes D, Shetterly SM, Hamman RF. Association of antibodies to beta2-glycoprotein I with pregnancy loss and pregnancy-induced hypertension: a prospective study in low-risk pregnancy. Obstet Gynecol 1999; 93: 193-98.
7. Lee RM, Brown MA, Branch DW, Ward K, Silver RM. Anticardiolipin and anti-β2-glycoprotein-I antibodies in preeclampsia. Obstet Gynecol 2003; 102: 294-300.
8. Fialova L, Mikulikova L, Matous-Malbohan I, Benesova O, Zwinger A. Prevalence of various antiphospholipid antibodies in pregnant women. Physiol Res 2000; 49: 299-305.
9. Topping J, Quenby S, Farquharson R, Malia R, Greaves M. Marked variation in antiphospholipid antibodies during pregnancy: relationships to pregnancy outcome. Human Reprod 1999; 14: 224-28.
10. Matthiesen LS, Berg G, Ernerudh J, Skogh T. A prospective study on the occurrence of autoantibodies in low-risk pregnancies. Eur J Obstet Gynecol Reprod Biol 1999; 83: 21-26.
11. Faden D, Tincani A, Tanzi P, Spatola L, Lojacono A, Tarantini M, Balestrieri G. Anti-beta 2 glycoprotein I antibodies in a general obstetric population: preliminary results on the prevalence and correlation with pregnancy outcome. Anti-beta2 glycoprotein I antibodies are associated with some obstetrical complications, mainly preeclampsia-eclampsia. Eur J Obstet Gynecol Reprod Biol 1997; 73: 37-42.
12. Dekker GA, de Vries JI, Doelitzsch PM, Huijgens PC, von Blomberg BM, Jakobs C, van Geijn HP. Underlying disorders associated with severe early-onset preeclampsia. Am J Obstet Gynecol 1995; 173: 1042-48.
13. Bowen RS, Moodley J, Dutton MF, Fickl H. Antibodies to oxidised low-density lipoproteins and cardiolipin in pre-eclampsia and eclampsia. J Obstet Gynaecol 2002; 22: 123-26.
14. Valdés-Macho E, Cabiedes J, Villa A, Cabral A, Alarcón-Segovia D. Anticardiolipin and anti-β2-glycoprotein-I antibodies in hypertensive disorders of pregnancy. Arch Med Res 2002; 33: 460-65.
15. Branch DW, Porter TF, Rittenhouse L, Caritis S, Sibai B, et al. Antiphospholipid antibodies in women at risk for preeclampsia. Am J Obstet Gynecol 2001; 184:825-34.
16. Dreyfus M, Hedelin G, Kutnahorsky R, Lehmann M, Viville B, Langer B, et.al. Antiphospholipid antibodies and preeclampsia: a case-control study. Obstet Gynecol 2001; 97: 29-34.
17. Zeeman GG, Alexander JM, McIntire DD, Leveno KJ. The significance of antiphospholipid antibodies in pregnant women with chronic hypertension. Am J Perinatol 2004; 21: 275-79
.
18. De Laat HB, Derksen RH, de Groot PG. β2-Glycoprotein I, the playmaker of the antiphospholipid syndrome. Clin Immunol 2004; 112: 161-68.
19. Lee RM, Emlen W, Scott JR, Branch DW, Silver RM. Anti-beta2-glycoprotein I antibodies in women with recurrent spontaneous abortion, unexplained fetal death, and antiphospholipid syndrome. Am J Obstet Gynecol 1999; 181: 642-48.
20. Lee RM, Brown MA, Branch DW, Ward K, Silver RM. Anticardiolipin and anti-β2-glycoprotein-I antibodies in preeclampsia. Obstet Gynecol 2003; 102: 294-300.
21. Gómez JM, García HI, Gómez J, Quintero A, Mesa CM, Aguirre N. Asociación entre anticardiolipina y anti β2 glicoproteína I con preeclampsia antes de las 35 semanas de gestación. Rev Colomb Obstet Ginecol 2001; 52: 1-10.
22. Galli M, Barbui T. Antiphospholipid antibodies and pregnancy. Best Pract Res Clin Haematol 2003; 16: 211-25.90 Rev Fac Cien Med (Quito) 2007; 32 (2)
23. Galli M, Luciani D, Bertolini G, Barbui T. Anti-β2-glycoprotein I, antiprothrombin antibodies, and the risk of thrombosis in the antiphospholipid syndrome. Blood 2003; 102: 2717-23.
24. Bowen RS, Moodley J, Dutton MF, Fickl H. Antibodies to oxidised low-density lipoproteins and cardiolipin in pre-eclampsia and eclampsia. J Obstet Gynaecol 2002; 22: 123-26.
25. Espinosa G, Cervera R, Font J, Shoenfeld Y. Antiphospholipid syndrome: pathogenic mechanisms. Autoimmunity Reviews 2003; 2: 86-93
