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2016, Número 1

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Rev cubana med 2016; 55 (1)


Identificación de predictores serológicos de recaída en pacientes con lupus eritematoso sistémico: estudio prospectivo de 12 meses

Kokuina E, Estévez TM, Gutiérrez RÁ, Ortiz LA, Sánchez BY, Pérez CD, Argüelles ZA, Chico CA, Casas FN

Idioma: Español
Referencias bibliográficas: 51
Paginas: 30-45
Archivo PDF: 226.92 Kb.


RESUMEN

Introducción: las investigativos efectuadas no han tenido éxito en la búsqueda de biomarcadores serológicos o clínicos suficientemente confiables para predecir las recaídas en el lupus eritematoso sistémico (LES).
Objetivo: definir el valor predictivo de las especificidades de anticuerpos antinucleares para la recaída del LES y de la nefritis lúpica.
Métodos: estudio analítico, observacional, longitudinal y prospectivo en 120 pacientes adultos con LES inactivo (SLEDAI-2K ≤ 5 puntos). La presencia basal de siete especificidades antinucleares, C3 y C4 bajos se correlacionaron con la ocurrencia de recaída del LES (incrementos en la puntuación de SLEDAI-2K ≥ 4) y de la nefritis lúpica mediante análisis univariado. Las variables más valiosas fueron evaluadas adicionalmente como predictoras con un modelo de regresión logística multivariada para calcular los odds ratio (OR).
Resultados: las recaídas del LES y de la nefritis lúpica se observaron en 51 (42,5 %) y 29 (24,2 %) de los pacientes, respectivamente. En el análisis multivariado emergieron como factores de riesgo para la recaída del LES la presencia de los anticuerpos anti-Nu (OR= 1523,0; p ‹ 0,001) y los anti-DNAdc (OR= 12,1; p= 0,044) y de la nefritis lúpica, los anti-Nu (OR= 92,9; p ‹ 0,001) y el C3 bajo (OR= 7,1; p= 0,007), La subrepresentación de los anti-RNP resultó un factor de riesgo para la recaída del LES y de la nefritis lúpica (OR= 0,023; p= 0,009 y OR= 0,1; p= 0,025).
Conclusiones: los pacientes con LES positivos de anticuerpos anti-Nu, anti-DNAdc o niveles bajos del C3 presentaron un riesgo mayor de recaída del LES y de la nefritis lúpica en los próximos 12 meses, lo que señala la necesidad de estrechar su monitoreo clínico.


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