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Том 12 №3 2010 год - Нефрология и диализ

Катастрофический антифосфолипидный синдром у молодой больной системной красной волчанкой

Козловская Н.Л. Томилина Н.А. Столяревич Е.С. Бирюкова Л.С. Скрябина И.А. Кальянова Е.В. Варясин В.В. Жукова М.Е.

Аннотация: В статье приводятся сведения о КАФС, в том числе основные концепции патогенеза, клинические проявления, морфологические особенности, подходы к диагностике и лечению, подчеркиваются его отличия от классических вариантов АФС – первичного и вторичного при СКВ. Обзор иллюстрирован клиническим наблюдением больной КАФС, развившимся как основное проявление СКВ. На примере представленного случая разбираются некоторые аспекты дифференциальной диагностики КАФС с другими микроангиопатическими синдромами – ГУС/ТТП и ДВС.

Для цитирования: Козловская Н.Л., Томилина Н.А., Столяревич Е.С., Бирюкова Л.С., Скрябина И.А., Кальянова Е.В., Варясин В.В., Жукова М.Е. Катастрофический антифосфолипидный синдром у молодой больной системной красной волчанкой. Нефрология и диализ. 2010. 12(3):208-219. doi:

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Ключевые слова: катастрофический антифосфолипидный синдром (КАФС), системная красная волчанка (СКВ), тромботическая тромбоцитопеническая пурпура, тромботическая микроангиопатия, ДВС-синдром, полиорганная недостаточность, catastrophic antiphospholipid syndrome (CAPS), systemic lupus erythematosus (SLE), thrombotic thrombocytopenic purpura, trombotic microangiopathies, disseminated intravascular coagulation syndrome

Список литературы:

1. Тареева И.Е., Янушкевич Т.Н., Шилов Е.М., Милованов Ю.С., Романова М.Д. Быстропрогрессирующий волчаночный нефрит.// Терапевтический архив. 1990. № 6. С. 46-49.
2. Amital H, Levy Y, Davidson D et al. Catastrophic antiphospholipid syndrome: remission following leg amputation in 2 cases. //Semin Arthritis Rheum. 2001.Vol. 31.P.127-132.
3. Appel G.B., Pirani C.L., D´Agati V. Renal vascular complications of systemic lupus erythematosus.// J Am Soc Nephrol.1994.Vol. 4.P.1499-1515.
4. Asherson RA. The catastrophic antiphospholipid syndrome. //J Rheumatol.1992. Vol.19. P.508-512.
5. Asherson RA. The catastrophic antiphospholipid syndrome, 1998. A review of the clinical features, possible pathogenesis and treatment.// Lupus. 1998. Vol. 7. P. S55-S62.
6. Asherson RA, Cervera R. Catastrophic antiphospholipid syndrome. //Curr Opin Hematol. 2000.Vol. 7. P. 325-329.
7. Asherson RA, Shoenfeld Y. The role of infection in the pathogenesis of catastrophic antiphospholipid syndrome – molecular mimicry? //J Rhematol. 2000. Vol. 27. P. 12-14.
8. Asherson RA, Cervera R., Piette J-C. et al. Catastrophic antiphospholipid syndrome. Clues to the pathogenesis from a series of 80 patients. //Medicine. 2001. Vol. 80. P. 355-377.
9. Asherson RA, Espinosa G, Cervera R, et al. Catastrophic antiphospholipid syndrome. Proposed guidelines for diagnosis and treatment. //J Clin Rheumatol. 2002. Vol. 8. P. 157-165.
10. Asherson RA, Cervera R, de Groot P et al. Catastrophic antiphospholipid syndrome (CAPS): International consensus statement on classification criteria and treatment guidelines.// Lupus. 2003. Vol. 12.P. 530-534.
11. Asherson RA. Acute respiratory distress syndrome and other unusual manifestations of the catastrophic antiphospholipid (Asherson's) syndrome.// IMAJ 2004.Vol. 6. P. 360-363.
12. Asherson RA, Espinosa G, Cervera R, et al. Disseminated intravascular coagulation in catastrophic antiphospholipid syndrome: clinical and haematological characteristics in 23 patients. //Ann Rheum Dis. 2005. Vol.64.P. 943-946.
13. Asherson RA, Espinosa G, Menahen S et al. Relapsing catastrophic antiphospholipid syndrome: report of three cases. //Semin Arthritis Rheum. 2008; Vol. 37. P. 366-372.
14. Banfi G., Bertani T., Boery V. et al. Renal vascular lesions as a marker of poor prognosis in patients with lupus nephritis. //Am J Kidney Dis. 1991. Vol. 18. P. 240-248.
15. Bayraktar U, Erkan D, Bucciarelli S et al. The clinical spectrum of catastrophic antiphospholipid syndrome in the absence and presence of lupus. // J Rheumatol. 2007.Vol.34. P. 346-352.
16. Blake JS, Butani L. Rapidly progressive lupus glomerulonephritis and concomitant microangiopathy in an adolescent. //Lupus.2002. Vol.11. P. 533-535.
17. Bone RC. Why new definitions of sepsis and organ failure are needed? // Am J Med. 1993. Vol.95. P. 348.
18. Brealy D, Singer M. Multi-organ dysfunction in the critically ill: effects on different organs. //R Coll Phys. London. 2000. Vol.34. P. 428-436.
19. Bridoux F., Vrtovsnik F., Noel Ch. et al. Renal thrombotic microangiopathy in systemic lupus erythematosus: clinical correlations and long-term renal survival.// Nephrol Dial. Transplant. 1998. Vol. 13. P. 298 – 304
20. Bucciarelli S, Espinosa G, Asherson RA, et al. The acute respiratory distress syndrome in catastrophic antiphospholipid syndrome: analysis of a series of 47 patients.// Ann Rheum Dis. 2006.Vol.65. P. 81-86.
21. Bucciarelli S, Espinosa G, Cervera R et al. Mortality in the catastrophic antiphospholipid syndrome. Causes of death and prognostic factors in a series of 250 patients.// Arthritis Rheum. 2006. Vol. 54(8). P. 2568-2576.
22. Bucciarelli S, Espinosa G, Cervera R. The CAPS Registry: morbidity and mortality of the catastrophic antiphospholipid syndrome. //Lupus. 2009.Vol. 18(10). P. 905-912.
23. Cappell MS. Esophageal necrosis and perforation associated with the anticardiolipin antibody syndrome.// Am J Gastroenterol.1994. Vol.89. P. 1241-1245.
24. Cerveny KC, Sawitzke AD. Relapsing catastrophic antiphospholipid antibody syndrome: a mimic for thrombotic thrombocytopenic purpura?// Lupus.1999. Vol.8. P. 477-481.
25. Cervera R, Font J, Gomez-Puerta JA et al. Validation of the preliminary criteria for the classification of catastrophic antiphospholipid syndrome. //Ann Rheum Dis. 2005. Vol. 64. P. 1205-1209.
26. Cervera R, Espinosa G., Cordero A. et al. Intestinal involvement secondary to the antiphospholipid syndrome (APS): clinical and immunologic characteristics of 97 patients: comparison of classic and catastrophic APS. //Semin Arthritis Rheum. 2007. Vol.36. P. 287-296.
27. Cervera R., Bucciarelli S., Plasin MA et al. Catastrophic antiphospholipid syndrome (CAPS): descriptive analysis of a series of 280 patients from the “CAPS Registry” // Journal Autoimmun.2009. Vol. 32(3-4). P. 240-245.
28. Cohen J. The immunopathogenesis of sepsis.// Nature 2002. Vol. 420. P. 885-891.
29. Descombes E., Droz D., Drouet L. et al. Renal vascular lesions in lupus nephritis.// Medicine. 1997. Vol.76. P. 355-368
30. Dessailloud R, Papo T, Vaneecloo S et al. Acalculous ischemic gall bladder necrosis in the catastrophic antiphospholipid syndrome. //Arthritis Rheum.1998. Vol.41. P. 1318-1320.
31. Drencard C, Sanchez-Guerrero J, Alarcon-Segovia D. Fall in antiphospholipid antibody at the time of thromboocclusive episodes in systemic lupus erythematosus.// J Rheumatol. 1989. Vol. 16. P. 614-617.
32. Erkan D, Asherson RA, Espinosa G. et al. Long term outcome of catastrophic antiphospholipid syndrome survivors. //Ann Rheum Dis. 2003. Vol. 62. P. 530-533.
33. Ercan D, Cervera R, Asherson RA. Сatastrophic antiphospholipid syndrome. Where do we stand? //Arthritis Rheum. 2003. Vol. 48. P. 3320-3327.
34. Erre GL, Pardini S, Faedda R, Passiu G. Effect of rituximab on clinical and laboratory features of antiphospholipid syndrome: a case report and a review of literature.// Lupus. 2008. Vol.17:.P. 50-55.
35. Espinosa G, Cervera R, Font J, Asherson RA. The lung in the antiphospholipid syndrome.// Ann Rheum Dis.2002.Vol. 61. P. 195-198.
36. Espinоsa G, Cervera R., Asherson RA. Catastrophic antiphospholipid syndrome and sepsis. A common link? //J Rheumatol. 2007. Vol. 34(5). P.923-926.
37. Espinosa G., Cervera R. Antiphospholipid syndrome. //Arthritis Res Therapy. 2008. Vol.10. P. 230-238.
38. Fakhouri F, Vernant JP, Veyradier A et al. Efficiency of curative and prophylactic treatment with rituximab in ADAMTS 13-deficient thrombotic thrombocytopenic purpura: a study of 11 cases. //Blood.2005. Vol. 106. P. 1932-1937.
39. Garcia-Carrasco M, Escarcega RO, Mendoza-Pinto C et al. Preventing death in the catastrophic antiphospholipid (Ascherson) syndrome. //IMAJ. 2007. Vol.9 P. 628-629.
40. Greisman S.G., Thayaparan R.S., Godwin TA.et al. Occlusive vasculopathy in systemic lupus erythematosus − association with anticardiolipin antibody. //Arch Intern Med. 1991.Vol.151. P. 389-392.
41. Griffiths M.H., Papadaki L., Neild G.H. The renal pathology of primary antiphospholipid syndrome: a distinctive form of endothelial injury. Quart. //J. Med. 2000. Vol. 93. P. 457-467.
42. Gunnewiek J.M, Van Der Hoeven J.C. Cardiac troponin elevations among critically ill patients.// Curr Opin Crit Care. 2004.Vol.10. P. 342-346.
43. Ingram S.B., Goodnight S.H, Bennet R.M. An unusual syndrome of a devastating non-inflammatory vasculopathy associated with anticardiolipin antibodies: a report of two cases. //Artritis Rheum. 1987. Vol. 30. P. 1167-1172.
44. Jurgensen J.S, Kettritz R., Schneider W. et al. Catastrophic antiphospholipid syndrome masquerading as ischemic colitis.// Rheumatol Int. 2003. Vol. 23. P. 204-206.
45. Kitchens C.S. Thrombotic storm: when thrombosis begets thrombosis. //Am J Med. 1998.Vol.104. P. 381-385.
46. Kwok S.K, Ju J.H, Cho C.S. at al. Thrombotic thrombocytopenic purpura in systemic lupus erythematosus: risk factors and clinical outcome: a single centre study.// Lupus. 2009. Vol. 18. P.16-21.
47. Laterza O.F, Nayer H., Jo Bill M. et al. Unusually high concentration of cTnI and cTnT in a patient with catastrophic antiphospholipid antibody syndrome.// Clin Chim Acta. 2003. Vol. 337 P. 173-176.
48. Levy M.M, Fink M.P, Marshall J.C et al. SCCM/ESICM/ACCPATS/SIS International Sepsis Definitions Conference. // Crit Care Med. 2003. Vol.31. P. 1250-1256.
49. Manadan A.M, Harris C, Schwartz M.M. The frequency of thrombotic thrombocytopenic purpura in patients with systemic lupus erythematosus undergoing kidney biopsy. //J Rheumatol. 2003.Vol. 30.P. 1227-1230.
50. Meroni P.L, Raschi E, Camera G.et al. Endothelial activation by aPL: a potential pathogenetic mechanism for the clinical manifestation of the syndrome.// J Autoimmun. 2000. Vol. 15. P. 237-240.
51. Mizuno R., Fujimoto S., Fujimoto T.et al. Catastrophic antiphospholipid antibody syndrome in systemic lupus erythematosus: an autopsy case report of a young woman. //Internal Medicine. 2000. Vol. 39. P. 856-859.
52. Olguin-Ortega L, Jara L.J, Becerra M. et al. Neurological involvement as a poor prognostic factor in catastrophic antiphospholipid syndrome: autopsy finding in 12 cases.// Lupus.2003. Vol.12.P. 93-98.
53. Pierangelli S.S, Vega-Ostertag M.E, Raschi E. et al. Toll-like receptor and antiphospholipid thrombosis: in vivo studies. //Ann Rheum Dis. 2007. Vol. 66. P. 1327-1333.
54. Rojas-Rodriguez J, Garcia-Carrasco M, Ramos-Casals M et al. Catastrophic antiphospholipid syndrome. Clinical description and triggering factors in eight patients.// J Rheumatol. 2000. Vol.27. P. 238-240.
55. Rottem M., Krause I., Fraser A. et al. Autoummune hemolytic anaemia in the antiphospholipid syndrome. //Lupus 2006. Vol.15. P. 473-477.
56. Rubenstein E., Arkfeld D., Metyas S. et al. Rituximab treatment for resistant antiphospholipid syndrome.// J Rheumatol. 2006. Vol.33. P. 355-357.
57. Schwartz M.M. Lupus vasculatis. //Contrib.Nephrol. 1992. Vol.99. P. 35-45.
58. Tektonidou M.G, Sotsiou F, Moutsopoulos H.M. Antiphospholipid syndrome (APS) nephropathy in catastrophic, primary and systemic lupus erythematosus-related APS. //J Rheumatol. 2008. Vol.35. P.1983-1988.
59. Uthman I, Khamashta M. The abdominal manifestations of the antiphospholipid syndrome. //Rheumatology.2007.Vol. 46. P. 1641-1647.
60. Vora S.K, Asherson R.A, Ercan D. Catastrophic antiphospholipid syndrome.// J Intensive Care Med. 2006. Vol. 21. P. 144-159.
61. Wiedermann F.J., Mayr A., Schobersberger W. et al. Acute respiratory failure associated with catastrophic antiphospholipid syndrome.// J Intern Med. 2000. Vol.247. P. 723-730.
62. Yamamoto H., Iwade T., Nakano R. et al. Numerous small vegetations revealing Libman-Sacks endocarditis in catastrophic antiphospholipid syndrome.// Circulation.2007. Vol.116.Р.531-535.
63. Yu F., Tan Y., Zhao M-H. Lupus nephritis combined with renal injury due to thrombotic thrombocytopaenic purpura-haemolytic uraemic syndrome. //Nephrol Dial Transplant. 2010. Vol.25.P. 145-152.

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