原发性抗磷脂综合征中枢神经系统受累患者临床特征及影响因素分析  

Clinical characteristics and influencing factors of central nervous system involvement in patients with primary antiphospholipid syndrome

作　　者：刘梅歌 李公明 宋晓东 刘尊敬 李春[3] 范洋溢[1] LIU Meige;LI Gongming;SONG Xiaodong;LIU Zunjing;LI Chun;FAN Yangyi(不详;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,100044 [2]临沂市中医医院,276037 [3]北京大学人民医院风湿免疫科,100044

出　　处：《中国神经免疫学和神经病学杂志》2023年第4期251-255,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：北京市自然科学基金(7192211);中华国际医学交流基金(Z-2018-40-2101);北京大学人民医院研究与发展基金(RDE 2021-17)。

摘　　要：目的研究原发性抗磷脂综合征(primary antiphospholipid syndrome,PAPS)中枢神经系统受累的情况及影响因素。方法收集2002年6月至2021年12月在北京大学人民医院就诊的PAPS患者的病历资料进行回顾性分析,比较有无PAPS中枢神经系统受累两组患者的一般资料、临床特征、传统心脑血管危险因素、实验室检查和药物治疗等方面的差异,然后将上述差异具有统计学意义的变量纳入多因素Logistic回归模型,分析PAPS中枢神经系统受累的影响因素。结果共纳入177例PAPS患者,其中中枢神经系统受累患者43例,无中枢神经系统受累者134例。PAPS中枢神经系统受累最常见的临床表现为缺血性脑梗死〔34例(79.1%)〕。与无中枢神经受累组相比,PAPS中枢神经系统受累组患者的年龄更大,男性患者比例、颅外动脉事件患者比例、血小板减少患者比例、LA阳性率更高(均P<0.05),传统心脑血管危险因素中的高血压、糖尿病、血脂异常、吸烟患者比例也更高,病态妊娠比例更低(均P<0.05)。治疗方面,PAPS中枢神经系统受累组抗凝药、羟氯喹的使用率显著低于无中枢神经系统受累组(均P<0.05)。多因素Logistic回归分析表明,血脂异常显著增加了PAPS患者出现中枢神经系统受累的风险〔OR(95%CI)=4.888(1.455~16.425),P=0.010〕,合并病态妊娠〔OR(95%CI)=0.133(0.034~0.512),P=0.003〕、使用抗凝药〔OR(95%CI)=0.238(0.081~0.696),P=0.009〕和羟氯喹〔OR(95%CI)=0.306(0.110~0.855),P=0.024〕显著减少了PAPS患者出现中枢神经系统受累的风险。结论合并病态妊娠的PAPS患者出现中枢神经系统受累的比例显著低于无病态妊娠者。血脂异常是PAPS神经系统受累的危险因素,抗凝药和羟氯喹的使用是保护因素。Objective To investigate the clinical characteristics and influencing factors in patients with primary antiphospholipid syndrome(PAPS)complicated central nervous system(CNS)involvement.Methods A retrospective study was conducted in Peking University People's Hospital from June 2002 to December 2021.The patients were divided into two groups according to the presence of CNS involvement,the differences between the patients with or without CNS involvement were compared,including clinical features,laboratory parameters,traditional cardiovascular risk factors,and treatments.Those factors which were statistically significant in the univariate analysis were included in the multiple logistic regression models to analyse the influencing factors of CNS involvement in patients with PAPS.Results A total of 177 patients was recruited,including 43 with CNS involvement,and 134 without CNS involvement.The most common clinical manifestation of CNS involvement in PAPS was ischaemic stroke[34 cases(79.1%)].Compared with the group without CNS involvement,the patients with CNS involvement showed older age,higher proportion of male,extracranial arterial events,thrombocytopenia,higher proportion of positive lupus anticoagulan(LA)antibody,and more traditional cardiovascular risk factors(hypertension,diabetes mellitus,dyslipidaemia and smoking),and lower proportion of pathological pregnancy(all P<0.05).Regarding treatment regimens,the proportion of patients treated with anticoagulants and hydroxychloroquine(HCQ)was lower in the group with CNS involvement(all P<0.05).The multivariate logistic regression analysis showed that dyslipidaemia significantly increased the risk of CNS involvement in patients with PAPS[OR(95%CI)=4.888(1.455-16.425),P=0.010],while pathological pregnancy[OR(95%CI)=0.133(0.034-0.512),P=0.003],the use of anticoagulants[OR(95%CI)=0.238(0.081-0.696),P=0.009]and hydroxychloroquine[OR(95%CI)=0.306(0.110-0.855),P=0.024]significantly reduced the risk of CNS involvement in patients with PAPS.Conclusions The patients complicat

关 键 词：原发性抗磷脂综合征 中枢神经系统 影响因素 抗凝药物 羟氯喹 

分 类 号：R747.9[医药卫生—神经病学与精神病学] R593.2[医药卫生—临床医学]