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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2013, Número 3

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Rev Invest Clin 2013; 65 (3)


Factores de riesgo para el desarrollo de complicaciones trombóticas en pacientes con lupus eritematoso sistémico y nefropatía lúpica

Zaldívar-Alcántara H, Herrera-Jiménez LE, Dehesa-López E,Correa-Rotter R

Idioma: Español
Referencias bibliográficas: 31
Paginas: 199-208
Archivo PDF: 162.00 Kb.


RESUMEN

Introducción. Los eventos trombóticos constituyen una complicación frecuente en pacientes con lupus eritematoso sistémico (LES) y se asocian con un incremento sustancial en la morbilidad y mortalidad de estos pacientes. Objetivo. Identificar factores clínicos o de laboratorio asociados con el desarrollo de trombosis arterial o venosa en pacientes con LES y nefropatía lúpica (NL). Resultados. Se incluyeron 200 pacientes con el diagnóstico de LES y NL. Se observaron 25 eventos trombóticos en 23 pacientes, de los cuales 68% (n = 17) se presentaron en el lecho venoso. La tasa de incidencia global para eventos trombóticos fue de 29.1 por 1,000 pacientes-año. La NL clase IV fue la más frecuente con 40.8% de los casos. No se encontraron diferencias estadísticamente significativas en la distribución de las diferentes clases de NL, TFGe, magnitud de la proteinuria y en los marcadores de actividad lúpica entre los pacientes con y sin complicaciones trombóticas. En el análisis multivariado, el diagnóstico de síndrome antifosfolípidos (SAF) previo (RM = 126; IC95% 11.3-1419; p ‹ 0.001), el antecedente personal de trombosis arterial (RM = 24; IC95% 1.8-314; p = 0.01) y la serositis (RM = 5; IC95% 0.95-26.9; p = 0.05) se asociaron en forma independiente con el desarrollo de trombosis, y la administración de IECAS presentó un efecto protector (RM = 0.19; IC95% 0.03-0,98; p = 0.04). Conclusiones. Las complicaciones trombóticas en nuestra población fueron frecuentes. Los factores de riesgo relacionados con trombosis fueron el antecedente personal de trombosis arterial, serositis y el diagnóstico de SAF. El uso de IECAS se asoció con una reducción en el riesgo para el desarrollo de complicaciones trombóticas. No se encontró un mayor o menor riesgo de trombosis con factores renales como: proteinuria, tipo histológico de NL y TFGe.


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