Antiphospholipid syndrome and pulmonary involvement
DOI:
https://doi.org/10.11603/bmbr.2706-6290.2021.4.12552Keywords:
antiphospholipid syndrome; lungs, pulmonary embolism, antiphospholipid antibodiesAbstract
Summary. Antiphospholipid syndrome is characterized by venous and arterial thrombosis and severe complications that frequently lead to deaths. The production of antiphospholipid antibodies (anticardiolipin antibodies, antibodies to β2-glycoprotein 1 and lupus antibodies) contributes to damage, mainly to the endothelium of the vascular wall, which triggers the mechanism of hypercoagulation and thrombosis. Antiphospholipid antibodies may contribute to the development of organ dysfunction through the interrelated mechanisms of the immune response and the haemostasis system. Their effect on the pulmonary system is studied insufficiently; it is important for timely diagnosis of antiphospholipid syndrome.
The aim of the study – to analyse and systematize the literature in order to assess the frequency and causes of antiphospholipid syndrome, its pathogenesis and mechanisms of lung damage in cases of this disorder.
Materials and Methods. The information from the Internet sources, world and Ukrainian professional publications, medical database MEDSCAPE/PubMed for the last decade has been studied.
Results. Clinical studies of the patients with antiphospholipid syndrome and pulmonary complications have shown ambiguity in approaches to verification and treatment. The exact cause of this syndrome is not understood completely. Its main consequences are the activation of the hypercoagulation and thrombosis that cause tissue ischemia or even multiple organ failure. This is triggered by formation of three types of antiphospholipid autoantibodies. However, antiphospholipid antibodies are not always revealed in the patients with antiphospholipid syndrome with clinical manifestations. Then seronegative antiphospholipid syndrome is diagnosed. The clinical spectrum of manifestations associated with the presence of antiphospholipid antibodies is gradually expanding including the description of several pulmonary manifestations. These are pulmonary embolism, pulmonary hypertension, acute respiratory distress syndrome, fibrous alveoli. One of the infectious diseases in which antiphospholipid antibodies (APA) are formed is SARS-CoV-2, especially in severe cases. Management of patients with complications after COVID-19 is an urgent issue these days.
Conclusions. Insufficient study of the mechanisms of pulmonary involvement in antiphospholipid syndrome is the impetus for new research in this field of medicine. Discovery of the pathogenetic mechanisms of autoimmune antibody production and their role in development of this pathology are essential for a clear diagnosis. Most pulmonary complications are severe, often resulting in patient death.
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