Prevalencia y significado clínico de los anticuerpos antifosfolipídicos en la hepatitis crónica por virus C
Manuel Romero Gómez
, Enrique García-Díaz, Ana Guil, M. Ángeles Otero, Emilio Suárez García, Manuel Castro Fernández
Autor para correspondencia
mromerog@meditex.es
Correspondencia: Dr. M. Romero Gómez. Juan Antonio Cavestany, 1, 4.° G. 41003 Sevilla.
Correspondencia: Dr. M. Romero Gómez. Juan Antonio Cavestany, 1, 4.° G. 41003 Sevilla.
Servicios de Digestivo y Hospital Universitario de Valme. Sevilla
a Servicios de Digestivo y Hematología. Hospital Universitario de Valme. Sevilla
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Ángeles Otero, Emilio Suárez García, Manuel Castro Fernández" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Manuel Romero" "apellidos" => "Gómez" "email" => array:1 [ 0 => "mromerog@meditex.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Enrique" "apellidos" => "García-Díaz" ] 2 => array:2 [ "nombre" => "Ana" "apellidos" => "Guil" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Ángeles Otero" ] 4 => array:2 [ "nombre" => "Emilio Suárez" "apellidos" => "García" ] 5 => array:2 [ "nombre" => "Manuel Castro" "apellidos" => "Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicios de Digestivo y Hospital Universitario de Valme. Sevilla" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Dr. M. Romero Gómez. Juan Antonio Cavestany, 1, 4.° G. 41003 Sevilla." ] ] ] 1 => array:3 [ "autoresLista" => "Daniel López Lacomba, Reyes Gutiérrez, Inmaculada Marchante" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Daniel López" "apellidos" => "Lacomba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Reyes" "apellidos" => "Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Inmaculada" "apellidos" => "Marchante" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicios de Digestivo y Hematología. Hospital Universitario de Valme. Sevilla" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1999-09-22" "fechaAceptado" => "2000-01-18" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec220530" "palabras" => array:6 [ 0 => "Cirrosis hepática" 1 => "Anticuerpos anticardiolipina IgG" 2 => "Anticuerpos anticardiolipina IgM" 3 => "Anticoagulante lúpico" 4 => "Síndrome antifosfolípido" 5 => "Infección crónica por virus C" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudiar la prevalencia de anticuerpos antifosfolipidicos y analizar su relacion con laprogresion de la hepatitis cronica por virus C.</p> <span class="elsevierStyleSectionTitle">Metodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se incluyen 128 pacientes con hepatopatia cronica por VHC (edad 46 [14] anos, 70 varones),no tratados con interferon y un grupo control sano de 93 personas. Analizamos los factores deriesgo, la duracion de la enfermedad, el consumo de alcohol, la cifra de plaquetas, ALT, ARN delVHC en suero e higado y anticuerpos antinucleares, el grado de inflamacion y el estadio de fibrosisen la biopsia hepatica, el estadio de Child-Pugh, la existencia de hipertension portal y descompensacionesprevias. Estudiamos la presencia de anticoagulante lupico y anticuerpos anticardiolipina(ACA) IgG e IgM. En los pacientes con anticuerpos anticardiolipina positivos se detecto la presenciade anti-β2 glucoproteina I mediante ELISA.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presentaron anticuerpos antifosfolipidicos positivos 31/128 (25%; intervalo de confianza[IC] del 95%: 17,8–33,4). La prevalencia de anticuerpos anticardiolipina IgG fue significativamentemayor en pacientes (22%) que en controles 3/93 (3,2%), p < 0,05; en cambio, no encontramosdiferencias en la prevalencia de anticuerpos anticardiolipina IgM ni de anticoagulante lupico.No encontramos diferencias en las cifras de ALT, viremia, carga viral en higado, plaquetas o ANA enlos pacientes con anticuerpos anticardiolipina IgG o sin ellos, tampoco apreciamos relacion con laedad, la duracion de la infeccion, el consumo de alcohol ni los factores de riesgo. En 4 de 44 pacientes(9%, IC del 95%: 2,5–21,7) con fibrosis F1, en 7 de 39 (18%; IC del 95%: 7,5–33,5) conF2 y en 17 de 45 (38%; IC del 95%: 23,8–53,5) con cirrosis encontramos anticuerpos anticardiolipinaIgG positivo (p < 0,005). La presencia de ACA IgG se relaciono de forma significativa con laexistencia de hipertension portal, de disfuncion hepatica y antecedentes de descompensacion. En10 de 23 pacientes (43,5%; IC del 95%: 23,2–65,5) con ACA positivo se detectaron anticuerposanti-β2 glucoproteina I.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La cuarta parte de los pacientes con hepatitis cronica por VHC presentan anticuerposantifosfolipidicos. Estos anticuerpos podrian estar implicados en la progresion de la enfermedad.</p> <span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To know the prevalence of antiphospholipid antibodies in chronic hepatitis C and theirrelationship with disease progression.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">One hundred and twenty-eight patients with chronic hepatitis C and 93 healthy controlswere enrolled up. We determined platelets, ALT, γGT, RNAHCV in serum and liver and non-organspecific antibodies, grade and stage in liver biopsy, risk factors, duration of disease and alcohol intakewere also included. Portal hypertension and liver function parameters were studied. Antiphospholipidantibodies (APA): lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) (IgGand IgM) were measured by EIA. Anti-β2 glycoprotein I antibodies were also detected by EIA inACA positive patients.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Thirty one out of 128 (25%; 95%CI: 17.8%–33.4%) showed positive antiphospholipid antibodies.Positive ACA-IgG was higher in patients than controls (22% vs 3.2%; p < 0.05), whereas,ACA-IgM was similar (5% vs 3.2%; p = NS), and LA was absent in both groups. ALT levels, viraemia,viral load in liver, platelets, or ANA titre were similar in patients with and without positiveACA-IgG. Risk factors, duration of disease or alcohol intake were not related yet. Patients with stagingF1 showed positive ACA-IgG 4 of 44 (9%; 95%CI: 2.5%–21.7%), in staging F2 7 of 39 (18%;95%CI: 7.5%–33.5%) and in staging F4 17 of 45 (38%; 95%CI: 23.8%–53.5%; p < 0.005).ACA-IgG was significantly related to portal hypertension, Child-Pugh stage and presence of cirrhosiscomplications. Anti-β2 glycoprotein I antibodies were detected in ten (43.5%; CI95%: 23.2%–65.5%) out of 23 ACA positive patients.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">ACA-IgG seems to be associated with chronic hepatitis C, and could play a potentialrole in fibrosis progression and liver disease in these patients.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias Bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural history of liver fibrosis progression in patients with chronic hepatitis C The OBSVIRC, METAVIR, CLIMVIR, and DOSVIRC groups" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Poynard" 1 => "P. Bedossa" 2 => "P. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 1 | 0 | 1 |
| 2020 Junio | 4 | 0 | 4 |
| 2020 Febrero | 1 | 0 | 1 |
| 2018 Noviembre | 0 | 2 | 2 |
| 2017 Octubre | 7 | 2 | 9 |
| 2017 Septiembre | 6 | 6 | 12 |
| 2017 Agosto | 6 | 2 | 8 |
| 2017 Julio | 16 | 1 | 17 |
| 2017 Junio | 15 | 9 | 24 |
| 2017 Mayo | 15 | 1 | 16 |
| 2017 Abril | 15 | 1 | 16 |
| 2017 Marzo | 19 | 28 | 47 |
| 2017 Febrero | 13 | 8 | 21 |
| 2017 Enero | 17 | 0 | 17 |
| 2016 Diciembre | 33 | 3 | 36 |
| 2016 Noviembre | 29 | 2 | 31 |
| 2016 Octubre | 40 | 6 | 46 |
| 2016 Septiembre | 22 | 4 | 26 |
| 2016 Agosto | 15 | 3 | 18 |
| 2016 Julio | 12 | 1 | 13 |
| 2016 Junio | 28 | 1 | 29 |
| 2016 Mayo | 26 | 3 | 29 |
| 2016 Abril | 18 | 2 | 20 |
| 2016 Marzo | 19 | 0 | 19 |
| 2016 Febrero | 16 | 2 | 18 |
| 2016 Enero | 18 | 0 | 18 |
| 2015 Diciembre | 24 | 0 | 24 |
| 2015 Noviembre | 15 | 0 | 15 |
| 2015 Octubre | 29 | 0 | 29 |
| 2015 Septiembre | 34 | 0 | 34 |
| 2015 Agosto | 19 | 0 | 19 |
| 2015 Julio | 11 | 0 | 11 |
| 2015 Junio | 11 | 0 | 11 |
| 2015 Mayo | 34 | 0 | 34 |
| 2015 Abril | 16 | 0 | 16 |
| 2015 Marzo | 19 | 0 | 19 |
| 2015 Febrero | 15 | 0 | 15 |
| 2015 Enero | 21 | 0 | 21 |
| 2014 Diciembre | 14 | 0 | 14 |
| 2014 Noviembre | 7 | 0 | 7 |
| 2014 Octubre | 6 | 0 | 6 |
| 2014 Septiembre | 14 | 0 | 14 |
| 2014 Agosto | 7 | 0 | 7 |
| 2014 Julio | 3 | 0 | 3 |
| 2014 Junio | 6 | 0 | 6 |
| 2014 Mayo | 1 | 0 | 1 |
| 2014 Abril | 3 | 0 | 3 |
| 2014 Marzo | 12 | 0 | 12 |
| 2014 Febrero | 5 | 0 | 5 |
| 2014 Enero | 8 | 0 | 8 |
| 2013 Diciembre | 5 | 0 | 5 |
| 2013 Noviembre | 6 | 0 | 6 |
| 2013 Octubre | 10 | 0 | 10 |
| 2013 Septiembre | 4 | 0 | 4 |
| 2013 Agosto | 5 | 0 | 5 |
| 2000 Marzo | 1677 | 0 | 1677 |
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