抗磷脂综合征患者磷脂抗体外血栓的影响因素  

Influencing factors of thrombosis besides antiphospholipid antibodies in patients with antiphospholipid syndrome

作　　者：范洋溢[1] 陈辰 刘洪江[2] 蔡文心 侯玉珂 李春[2] Fan Yangyi;Chen Chen;Liu Hongjiang;Cai Wenxin;Hou Yuke;Li Chun(Department of Neurology,Peking University People′s Hospital,Beijing 100044,China;Department of Rheumatology and Immunology,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院神经内科,北京100044 [2]北京大学人民医院风湿免疫科,北京100044

出　　处：《中华医学杂志》2021年第43期3588-3593,共6页National Medical Journal of China

基　　金：北京市自然科学基金(7192211);北京大学人民医院研究与发展基金(RDY2019‑04)。

摘　　要：目的探讨抗磷脂综合征(APS)患者抗磷脂抗体外血栓的影响因素。方法选取2003年1月至2017年8月于北京大学人民医院就诊的资料齐全的APS患者169例,根据是否发生血栓将患者分为血栓组(100例)和非血栓组(69例)。纳入患者年龄为(41±15)岁,男23例,女146例。酶联免疫吸附试验(ELISA)法检测抗心磷脂抗体(aCL)、抗β2‑糖蛋白1抗体(β2GP1)、抗磷酯酰丝氨酸/凝血酶原(PS/PT)抗体,通过STA Compact凝血检测系统测定狼疮抗凝物(LA)。计算所有患者的全面APS评分(GAPSS)。比较血栓及非血栓患者抗磷脂抗体外其他临床及实验室指标的差异,通过二元logistic回归分析APS患者血栓的独立影响因素。结果血栓性APS患者年龄及病程显著高于非血栓性APS患者[(45±17)岁比(35±9)岁和M(Q_(1),Q_(3))12.0(3.8,84.0)个月比48.0(12.0,108.0)个月,均P<0.05],血栓性APS患者中男性、原发APS、吸烟、血小板减少、高血压、糖尿病的比例均高于非血栓性APS患者(均P<0.05)。血栓性APS患者抗核抗体阳性、aCL阳性、抗PS/PT抗体‑IgM阳性、抗PS/PT抗体‑IgG阳性比例及D二聚体水平均高于非血栓性APS患者(均P<0.05)。血栓患者GAPSS评分显著高于非血栓患者(均P<0.05),动脉血栓患者的评分更高(P<0.05)。二元logistic回归分析发现,吸烟(OR=11.222,95%CI:1.119~112.544,P=0.040)及D二聚体水平(OR=1.002,95%CI:1.000~1.003,P=0.037)是APS患者血栓的独立影响因素。结论血栓性APS患者年龄大,病程长,男性、原发APS、吸烟、高血压、血小板减少、糖尿病比例更高、GAPSS评分、D二聚体水平更高。吸烟及D‑二聚体水平升高是APS患者血栓的独立影响因素。Objective To identify the influencing factors of thrombosis besides antiphospholipid antibodies in patients with antiphospholipid syndrome(APS).Methods The 169 patients diagnosed with APS were enrolled according to the current APS classification criteria from January 2003 to August 2017 in Peking University People′s Hospital.There were 23 males and 146 females with a mean age of(41±15)years.Antiphospholipid antibodies,including anticardiolipin(aCL),anti-β2glycoprotein-1(β2GP1)antibodies and antibodies to the phosphatidylserine-prothrombin complex(aPS/PT),were determined by enzyme-linked immunosorbent assay(ELISA)methods.Lupus anticoagulant(LA)was identified using the STA Compact coagulation testing system.The differences of clinical and laboratory characteristics between patients with and without thrombosis were analyzed(100 cases and 69 cases,respectively).The influencing factors for thrombosis in patients with APS were determined using binary logistic regression.Results Compared with patients without thrombosis,patients with thrombosis were older and had a longer disease duration((45±17)years vs(35±9)years and M(Q_(1),Q_(3))12.0(3.8,84.0)months vs 48.0(12.0,108.0)months,both P<0.05).The percentage of male,primary APS,smoking,low blood platelet count,hypertension,and diabetes in patients with thrombosis were significantly higher than those in patients without thrombosis(all P<0.05).Similarly,the rates of antinuclear antibodies positive,aCL positive,aPS/PT-IgM positive,and aPS/PT-IgG positive in patients with thrombosis were significantly higher than those in patients without thrombosis(all P<0.05).The levels of D-dimer in patients with thrombosis were significantly higher than that in patients without thrombosis(P<0.05).There was significant difference in global anti-phospholipid syndrome score(GAPSS)between patients with and without thrombosis(P<0.05).The GAPSS score was also significantly higher in patients with arterial thrombosis than that in patients with venous thrombosis(P<0.05).Smoking and D-dimer

关 键 词：抗磷脂综合征 血栓 全面抗磷脂综合征评分 影响因素 

分 类 号：R593.2[医药卫生—内科学]