TI TÂM MC LIBMAN-SACKS)
TRONG HI CHNG ANTIPHOSPHOLIPID

Võ Tam
1
, Nguyễn Văn Tuấn
2

1

2



 kháng


 





 


gi


                  


 




 
      
 








              
phospholipids (coagulation test          





                -


-
 xác 
 




-

       





 
  -  

  -Glycop   

               


sàng.
1.
Kháng nguyên

Anti-Cardiolipin ELISA
LA Tests
ß
2
-Glycoprotein I
có
có/không
Prothrombin

không
có
Protein C
không
không
Protein S
không
không







cung 

ân




 -     


-- 65% b






nhân SLE kéo dài, làm 
-Sacks[17,18].
-



 

- aPLs







3.1 và LAs,





3.1

aPL Test
Có aPL

Khôngcó aPL


p
n
%
n
%
Khamashta et al
IgG and IgM aCL, LA
23/50
46
9/82
11
<.00
1
Nihoyannopoulos et al
IgG and IgM aCL
20/50
40
6/43
14

Cervera et al
IgG and IgM aCL, LA
15/23
65
16/47
34
<.05
Jouhikainen et al
LA
5/37

14
0/37
0
.05
Roldan et al
IgG and IgM aCL, LA,
VDRL
1

17/22
77
23/32
72
NS
Gleason et al
IgG and IgM aCL


8/20
40

Vianna et al
IgG and IgM aCL, LA
29/46
63



(
1

VDRL: false-positive Venereal Disease Research Laboratory test).
- aPLs 




.2.
.2 


aPL Test
PAPS

n
%
n
%
Brenner et al
IgG aCL, LA
11/34
32
1/22
5
Cervera et al
IgG aCL, LA
21/55
38
2/55
4
Galve et al

IgG and IgM aCL, LA
10/28
36
0/28
0
Vianna et al
IgG and IgM aCL, LA
18/51
35


(PAPS : APS tiên phát)




.
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






               

phát [25].

 van


             -   
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
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
-
         
-4 mm [12,13,14]. Các

 



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-
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





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
     

.


         man-Sacks


        
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


 
       



trùng [33] .


-Sacks là 
 

 



là -

2
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                   
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
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
n

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





nguyên  


th

tiên phát.

                 





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
                 
Kh
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



1. Hughes GRV, Harris EN, Gharavi AE. The anticardiolipin syndrome. J Rheumatol
1986;13:486-489.
2. Harris EN. A reassessment of the antiphospholipid syndrome. J Rheumatol
3. 1990;17:733-735.
4. Hughes GRV. The antiphospholipid syndrome: ten years on. Lancet 1993;342:341-344.
5. Triplett DA. Assays for detection of antiphospholipid antibodies. Lupus 1994;3:281-287.
6. Harris EN. Antiphospholipid antibodies. Br J Haematol 1990;74:1-9. Annotation.
7. Matsuura E, Igarashi Y, Yasuda T, Triplett DA, Koike T. Anticardiolipin antibodies
recognize ß
2
-glycoprotein I structure altered by interacting with an oxygen modified solid
phase surface. J Exp Med 1994;179:457-462.
8. Roubey RAS. Autoantibodies to phospholipid-binding plasma proteins: a new view of lupus
anticoagulants and other `antiphospholipid' autoantibodies. Blood 1994;84:2854-2867.
9. Harris EN, Chan JKH, Asherson RA, Aber VR, Gharavi AE, Hughes GRV. Thrombosis,
recurrent fetal loss and thrombocytopenia: predictive value of the anticardiolipin
antibody test. Arch Intern Med 1986;146:2153-2156.
10. Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus
anticoagulant in systemic lupus erythematosus (SLE) and non-SLE disorders
prevalence and clinical significance. Ann Intern Med 1990;112:682-698.
11. Reyes H, Dearing L, Shoenfeld Y, Peter JB. Antiphospholipid antibodies: a critique of
their heterogeneity and hegemony. Semin Thromb Hemost 1994;20:89-100.
12. Pierangeli SS, Barker JH, Stikovac D, Ackerman D, Anderson G, Barquinero J, Acland
R, Harris EN. Effect of human IgG antiphospholipid antibodies on an in vivo thrombosis
model in mice. Thromb Haemost 1994;71:670-674.
13. Libman E, Sacks B. A hitherto undescribed form of valvular and mural endocarditis.
Arch Intern Med 1924;33:701-737.
14. Baehr G, Klemperer K, Schifrin A. A diffuse disease of the peripheral circulation usually

associated with lupus erythematosus and endocarditis. Trans Assoc Am Physicians
1935;50:139-155.
15. Gross L. The cardiac lesion in Libman-Sacks disease with a consideration of its
relationship to acute diffuse lupus erythematosus. Am J Pathol 1940;16:375-408.
16. Shearn MA. The heart in systemic lupus erythematosus: a review. Am Heart J
1959;58:452-466.
17. Bridgen W, Bywaters EG, Lessof MH, Ross IP. The heart in systemic lupus
erythematosus. Br Heart J 1960;22:1-16.
18. Bulkley BH, Roberts WC. The heart in systemic lupus erythematosus and the changes
induced in it by corticosteroid therapy: a study of 36 necropsy patients. Am J Med
1975;58:243-264.
19. Galve E, Candell-Riera J, Pigrau C, Permanyer-Miralda G, Garcia-Del-Castillo H, Soler-
Soler J. Prevalence, morphologic types, and evolution of cardiac valvular disease in
systemic lupus erythematosus. N Engl J Med 1988;319:817-823.
20. Straaton KV, Chatham WW, Reveille JD, Koopman WJ, Smith SH. Clinically significant
valvular heart disease in systemic lupus erythematosus. Am J Med 1988;85:645-650.
21. Ford PM, Ford SE, Lillicrap DP. Association of lupus anticoagulant with severe valvular
heart disease in systemic lupus erythematosus. J Rheumatol 1988;15:597-600.
22. Asherson RA, Lubbe WF. Cerebral and valve lesions in SLE: association with
antiphospholipid antibodies. J Rheumatol 1988;15:539-543.
23. Chartash EK, Lans DM, Paget SA, Qamar T, Lockshin MD. Aortic insufficiency and
mitral regurgitation in patients with systemic lupus erythematosus and the
antiphospholipid syndrome. Am J Med 1989;86:407-412.
24. Nihoyannopoulos P, Gomez PM, Joshi J, Loizou S, Walport MJ, Oakley CM. Cardiac
abnormalities in systemic lupus erythematosus: association with raised anticardiolipin
antibodies. Circulation. 1990;82:369-375.
25. Roldan CA, Shively BK, Lau CC, Gurule FT, Smith EA, Crawford MH. Systemic lupus
erythematosus valve disease by transesophageal echocardiography and the role of
antiphospholipid antibodies. J Am Coll Cardiol 1992;20:1127-1134.
26. Vianna JL, Khamashta MA, Ordi-Ros J, Font J, Cervera R, Lopez-Soto A, Tolosa C,

Franz J, Selva A, Ingelmo M, Vilardell M, Hughes GRV. Comparison of the primary and
secondary antiphospholipid syndrome: a European multicenter study of 114 patients. Am
J Med 1994;96:3-9.
27. Giunta A, Picillo U, Maione S, Migliaresi S, Valentini G, Arnese M, Losardo L, Marone
G, Tirri G, Condorelli M. Spectrum of cardiac involvement in systemic lupus
erythematosus: echocardiographic, echo-Doppler observations and immunological
investigation. Acta Cardiol 1993;48:183-197.
28. Cervera R, Khamashta A, Font J, Reyes PA, Vianna JL, Lopez-Soto A, Amigo MC,
Asherson RA, Azqueta M, Pare C, Vargas J, Romero A, Ingelmo M, Hughes GRV. High
prevalence of significant heart valve lesions in patients with the primary antiphospholipid
syndrome. Lupus 1991;1:43-47.
29. Galve E, Ordi J, Barquinero J, Evangelista A, Vilardell M, Soler-Soler J. Valvular heart
disease in the primary antiphospholipid syndrome. Ann Intern Med 1992;116:293-298.
30. Barbut D, Borer JS, Gharavi A, Wallerson D, Devereux RB, Supino P, Suite NDA.
Prevalence of anticardiolipin antibody in isolated mitral or aortic regurgitation, or both,
and possible relation to cerebral ischemic events. Am J Cardiol 1992;70:901-905.
31. Pope JM, Canny CLB, Bell DA. Cerebral ischemic events associated with endocarditis,
retinal vascular disease, and lupus anticoagulant. Am J Med 1991;90:299-309.
32. Ford SE, Charette EJP, Knight J, Pym J, Ford P. A possible role for antiphospholipid
antibodies in acquired cardiac valve deformity. J Rheumatol 1990;17:1499-1503.
33. Nickele GA, Foster PA, Kenny D. Primary antiphospholipid syndrome and mitral valve
thrombosis. Am Heart J 1994;128:1245-1247.
34. Lehman TJA, Palmeri ST, Hastings C, Klippel JH, Plotz PH. Bacterial endocarditis
complicating systemic lupus erythematosus. J Rheumatol 1983;10:655-658.
35. McGrae KR, de Michelle A, Samuels P, Roth D, Kuo A, Meg QH, Rauch J, Cines DA.
Detection of endothelial cell reactive immunoglobulin in patients with antiphospholipid
antibodies. Br J Haematol 1991;79:595-605.
36. Cervera R, Khamashta MA, Font J, Ramirez J, Cruz D, Montalban J, Lopez-Soto A,
Asherson RA, Ingelmo M, Hughes GRVH. Antiendothelial cell antibodies in patients
with the antiphospholipid syndrome. Autoimmunity 1991;11:1-6.

37. Galli M, Bevers EM. Inhibition of phospholipid-dependent coagulation reactions by
`antiphospholipid antibodies': possible modes of action. Lupus 1994;3:223-228.
38. Bidani AK, Roberts JL, Schwartz MM, Lewis EJ. Immunopathology of cardiac lesions in
fatal systemic lupus erythematosus. Am J Med 1980;69:849-858.
39. Ziporen L, Goldberg I, Kopolovic Y, Arad M, Sandbank Y, Ordi-Rose J, Vilardell-
Tarress M, De Torres I, Adler Y, Weinberger A, Asherson RA, Shoenfeld Y. Libman
Sacks endocarditis: the possible pathogenic role of anti-cardiolipin antibodies deposited
at the valve subendothelium. Lupus. 1995;4(suppl 2):100.
40. Khamashta MA, Cuadrado MJ, Mujic F, Taub NA, Hunt BJ, Hughes GRV. The
management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med
1995;332:993-997.
41. Derksen RHWM, de Groot PG, Kater L, Nieuwenhuis HK. Patients with
antiphospholipid antibodies and venous thrombosis should receive long term
anticoagulant treatment. Ann Rheum Dis 1993;52:689-692.
42. Rosove MH, Brewer PMC. Antiphospholipid thrombosis: clinical course after the first
thrombotic event in 70 patients. Ann Intern Med 1992;117:303-308.