抗磷脂综合征相关循环系统表现  

Circulatory system manifestations of antiphospholipid antibody syndrome

作　　者：张金 李程 韩笑蓉 陈中波 王英慧 王宏[1] 王永刚[1] ZHANG Jin;LI Cheng;HAN Xiao-rong;CHEN Zhong-bo;WANG Ying-hui;WANG Hong;WANG Yong-gang(Department of Cardiology,the First Hospital of Jilin University,Changchun,Jilin 130000,China)

机构地区：[1]吉林大学第一医院心血管病诊治中心内科组,吉林长春130000

出　　处：《中华全科医学》2021年第9期1557-1561,共5页Chinese Journal of General Practice

基　　金：吉林省科技发展计划基金项目(20190701066GH);吉林省教委科研基金项目(JJKH20201046KJ)。

摘　　要：抗磷脂综合征是一种自身免疫性疾病,其特征是血液中的抗磷脂抗体持续阳性,与血栓形成、流产等疾病发生风险相关。目前抗磷脂综合征的诊断是基于符合最新札幌分类标准中至少一项临床表现和至少一项临床实验室标准。目前抗磷脂综合征越来越被认为是一种多器官、多系统疾病,其临床表现谱正逐渐扩大,可累及不同的器官系统,循环系统是抗磷脂综合征主要累及的靶器官系统之一。抗磷脂综合征相关循环系统表现的发病机制主要在2个方面,即自身免疫和血栓形成。常见的循环系统受累的临床表现包括血栓形成、心脏瓣膜病、缺血性心肌病、动脉粥样硬化、肺高压以及心室功能不全等。血管超声检查、超声心动图、计算机断层扫描、磁共振成像、核医学检查等非侵入性影像学检查技术是抗磷脂综合征相关循环系统表现的首选检查方法,冠状动脉造影等有创心脏检查会加剧血栓形成风险,不建议作为常规检查手段。抗凝是抗磷脂综合征患者治疗的基础,抗凝方案应基于抗磷脂综合征患者的危险分层进行选择。对于抗磷脂综合征患者是否可行经皮冠状动脉介入治疗及外科手术治疗等有创治疗目前仍存在争议。本文对抗磷脂综合征患者可能出现的相关循环系统表现及其发病机制、影像学检查、治疗策略进行阐述。Antiphospholipid syndrome is an autoimmune disease characterized by persistent positive antiphospholipid antibodies in the blood and associated with the risk of thrombosis,miscarriage and other disorders.The current diagnosis of antiphospholipid syndrome is based on meeting at least one of the clinical manifestations in the latest Sapporo Classification Criteria and at least one clinical laboratory standard.At present,antiphospholipid syndrome is more and more considered as a multi-organ and multi-system disease,and its clinical manifestation spectrum is gradually expanding,which can involve different organ systems.The circulatory system is one of the main target organ systems involved in antiphospholipid syndrome.The pathogenesis of antiphospholipid syndrome is mainly manifested in two aspects,namely,autoimmunity and thrombosis.The common clinical manifestations of circulatory involvement include thrombosis,valvular heart disease,ischemic cardiomyopathy,atherosclerosis,pulmonary hypertension and ventricular dysfunction.Non-invasive imaging techniques such as vascular ultrasound,echocardiography,computed tomography,magnetic resonance imaging and nuclear medical examination are the preferred methods used for investigating the circulatory system manifestations associated with antiphospholipid syndrome.Invasive heart tests,such as coronary arteriography,increase the risk of clots and are not recommended as routine tests.Anticoagulation is the basis of treatment of patients with antiphospholipid syndrome.The anticoagulation regimen should be selected on the basis of risk stratification of patients with antiphospholipid syndrome.The feasibility of percutaneous coronary intervention and surgical intervention is still controversial in patients with antiphospholipid syndrome.This review describes the possible circulatory manifestations,pathogenesis,imaging examination and treatment strategies of patients with antiphospholipid syndrome.

关 键 词：抗磷脂综合征 抗磷脂抗体 心脏瓣膜病 缺血性心肌病 动脉粥样硬化 肺高压 

分 类 号：R593.2[医药卫生—内科学]