Prévalence et signification clinique des anticorps antiphospholipidiques présents au diagnostic de patients atteints d'un purpura thrombopénique auto-immun

Le but de cette étude était d évaluer au moment du diagnostic de purpura thrombopénique auto-immun (PTAI), dans une large cohorte monocentrique, la fréquence et la signification de la présence d anticorps antiphospholipides (APL) [anticorps anti-cardiolipines (aCL) et anticoagulant circulant type lupique (ACC)] dont les chiffres sont actuellement controversés. Des APL ont été recherchés chez 215 adultes au moment du diagnostic de PTAI avec un nombre de plaquettes inférieur à 50x109/L. Or, la présence d'APL a été retrouvée chez 55 patients (26%) au diagnostic de PTAI : 42 (20%) avaient des IgG-aCL; 12 (6%) avaient des IgM-aCL sans IgG ; 1 avait un ACC isolé. Quinze malades avaient un ACC associé à des aCL. La présence d'un ACC était corrélée à un taux élevé d'IgG-aCL (>=40 U) (p=0,001). L âge, le sexe, le taux initial de plaquettes, le score hémorragique, l'évolution aiguë ou chronique du PTAI n'étaient pas associés à la présence d'APL, en dehors de l âge, plus bas en présence d un ACC (âge moyen : 29+-14 ans vs 45+-20 ans, p=0,002). Après un suivi médian de 31 mois, 14/215 (7%) patients ont thrombosé ; 4 étaient porteurs d'APL (IgG-aCL >=40 U toujours associés à un ACC). En analyse multivariée, l'apparition d'une thrombose était associée à l'âge (HR =1,6; IC95% 1,2-2,4), à la présence d'un ACC (HR=9,9; IC95% 2,3-43,4) ou à la présence d'un IgG-aCL à un taux >=40 U ) (HR=7,5; IC95% 1,8-31,5). En conclusion, la corrélation entre la présence d un ACC et d un taux important d IgG-aCL, et leurs associations à la survenue d une thrombose suggèrent que la recherche d APL au diagnostic de PTAI devrait être réalisée pour chaque patient au diagnostic.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Validation of a French version of the quality of life "Celiac Disease Questionnaire".

BACKGROUND AND OBJECTIVE: Celiac disease (CD) is a common chronic autoimmune disorder. Both the manifestations of the disease and the burden of the compulsory life-long gluten-free diet (GFD) have been shown to be associated with impairment of health-related quality of life. The objectives of this study were to provide a cross-cultural adaptation of the specific quality of life "Celiac Disease Questionnaire" (CDQ) and to analyze its psychometric properties. MATERIALS AND METHODS: A cross-cultural French adaptation of the CDQ (F-CDQ) was obtained according to the revised international guidelines. The questionnaire was administered at baseline to 211 patients with biopsy proven CD followed-up in a single tertiary referral centre. The questionnaire was also administered after 7 days and 6 months. Reliability (intraclass correlation coefficients (ICC), Cronbach's alpha and Bland and Altman graphical analysis), validity (factorial structure and Rasch analysis, convergent validity), and responsiveness (effect size) of the F-CDQ were studied. RESULTS: The reliability of the F-CDQ was excellent with ICC and Cronbach's alpha coefficients being between 0.79 and 0.94 for the four subscales and the total score. The factorial structure and the Rasch analysis showed that the four dimensions of the original instrument were retained. Correlations with external measures (a generic measure of quality of life, an anxiety and depression instrument, a self-assessed disease severity, and clinical manifestations) were all in the expected direction confirming the validity of the instrument. Responsiveness was studied and effect sizes ≥ 0.20 were demonstrated for most of the subscales for patients who reported improvement or deterioration after 6 months. CONCLUSION: The F-CDQ retains the psychometric properties of the original instrument and should be useful in cross-national surveys and to assess outcome in clinical trials involving patients with CD

Validation of a French Version of the Quality of Life “Celiac Disease Questionnaire”

<div><p>Background and Objective</p><p>Celiac disease (CD) is a common chronic autoimmune disorder. Both the manifestations of the disease and the burden of the compulsory life-long gluten-free diet (GFD) have been shown to be associated with impairment of health-related quality of life. The objectives of this study were to provide a cross-cultural adaptation of the specific quality of life “Celiac Disease Questionnaire” (CDQ) and to analyze its psychometric properties.</p><p>Materials and Methods</p><p>A cross-cultural French adaptation of the CDQ (F-CDQ) was obtained according to the revised international guidelines. The questionnaire was administered at baseline to 211 patients with biopsy proven CD followed-up in a single tertiary referral centre. The questionnaire was also administered after 7 days and 6 months. Reliability (intraclass correlation coefficients (ICC), Cronbach's alpha and Bland and Altman graphical analysis), validity (factorial structure and Rasch analysis, convergent validity), and responsiveness (effect size) of the F-CDQ were studied.</p><p>Results</p><p>The reliability of the F-CDQ was excellent with ICC and Cronbach's alpha coefficients being between 0.79 and 0.94 for the four subscales and the total score. The factorial structure and the Rasch analysis showed that the four dimensions of the original instrument were retained. Correlations with external measures (a generic measure of quality of life, an anxiety and depression instrument, a self-assessed disease severity, and clinical manifestations) were all in the expected direction confirming the validity of the instrument. Responsiveness was studied and effect sizes ≥0.20 were demonstrated for most of the subscales for patients who reported improvement or deterioration after 6 months.</p><p>Conclusion</p><p>The F-CDQ retains the psychometric properties of the original instrument and should be useful in cross-national surveys and to assess outcome in clinical trials involving patients with CD.</p></div

Bland and Altman graphical analysis of the reproducibility of the total score of the French version of the “Celiac Disease Questionnaire” (F-CDQ).

<p>Mean total score of the two F-CDQ assessments (baseline and retest 7 days later for patients who stated that their health status was unchanged) plotted against the difference of these two measures. The horizontal dotted lines indicate the mean difference ± 1 SD.</p

Socio-demographic and clinical characteristics of the patients with celiac disease included in the validation study of the French version of the “Celiac Disease Questionnaire”.

<p>*: disease severity was assessed on a visual analogue scale (0–10) with 10 indicating the most severe disease; CD: celiac disease; IQR: interquartile range. The MOS-SF36 scores are presented both as raw score and as age- and sex-adjusted standardised scores using the French general population reference values for age (10-year interval groups) and gender, and expressed as standard deviations (SD).</p

Sensitivity to change of the French version of the “Celiac Disease Questionnaire” (F-CDQ).

<p>Sensitivity to change of the French version of the “Celiac Disease Questionnaire” (F-CDQ).</p

Baseline subscale and total scores of the French version of the “Celiac Disease Questionnaire” and reliability.

<p>F-CDQ: French version of the “Celiac Disease Questionnaire”; the scores were normalised, ranging from 0 (worst score) to 100 (best score) for each subscale and the total F-CDQ score;</p><p>*: ICC computation was limited to the 112 of the 144 patients who participated in the test-retest study and who stated that their health status had not changed significantly between the two assessments;</p><p>**: Cronbach's α coefficients were computed from baseline data for the 211 individuals; ICC: intraclass correlation coefficient; 95% CI: 95% confidence interval.</p

Associations between the French version of the “Celiac Disease Questionnaire” (F-CDQ) and the MOS-36 and the HAD questionnaires.

<p>MOS-SF36: medical outcome study short-form 36 items; HAD: hospital anxiety and depression scale; *: Spearman correlation coefficients. Negative correlations coefficients were expected between F-CDQ subscales scores and the HAD as these two instruments score in the opposite directions. P<0.0001 of all correlations coefficients.</p

Association of the subscale scores for the French version of the “Celiac Disease Questionnaire” (F-CDQ) with gender, self-assessment of celiac disease severity and number of disease manifestations.

<p>*: self-reported disease severity assessed on a visual analogue scale (0–10) with 10 indicating the most severe disease; the F-CDQ scores were normalised, ranging from 0 (worst score) to 100 (best score) for each subscale and the total F-CDQ score.</p