原发性抗磷脂综合征并发脑梗死危险因素分析  

Risk factors of cerebral infarction in patients with primary antiphospholipid syndrome

作　　者：田真[1] 孔芳[1] 苏丽[1] 廖秋菊[1] 王雪[2] 赵义[1] Tian Zhen;Kong Fang;Su Li;Liao Qiuju;Wang Xue;Zhao Yi(Department of Rheumatology and Allergy,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Medical Information Laboratory,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院风湿免疫-变态反应科,北京100053 [2]首都医科大学宣武医院医学信息研究室,北京100053

出　　处：《中华风湿病学杂志》2023年第12期799-805,共7页Chinese Journal of Rheumatology

摘　　要：目的分析原发性抗APS(PAPS)并发脑梗死的临床特征和危险因素。方法回顾性分析2010—2020年于首都医科大学宣武医院住院诊治的145例PAPS患者,采用χ^(2)检验、t检验或Mann-Whitney U检验,比较有脑梗死和无脑梗死患者的临床特征、实验室指标和改良的APS总体评分系统(aGAPSS)评分,应用单变量和多变量Logistic回归分析筛选PAPS并发脑梗死的危险因素。结果纳入145例PAPS患者,中位年龄44.0(34.0,51.5)岁,女性占66.2%,其中46例(31.7%)并发脑梗死。与无脑梗死PAPS患者相比,脑梗死组短暂性脑缺血发作(TIA)(50.0%和20.2%,χ^(2)=13.37,P<0.001)、瓣膜异常(32.6%和11.1%,χ^(2)=9.86,P=0.002)、狼疮抗凝物(LA)阳性(87.0%和42.4%,χ^(2)=25.35,P<0.001)和抗磷脂抗体(aPL)三阳性[(50.0%和11.1%,χ^(2)=26.64,P<0.001)]的发生率更高,aGAPSS评分更高[13(11,14)分和9(7,13)分,U=934.50,P<0.001]。单变量和多变量Logistic回归分析结果表明,TIA[OR值(95%CI)=3.612(1.387,9.403,P=0.009)]、aPL三阳性[OR值(95%CI)=8.904(3.169,25.019),P<0.001]、aGAPSS评分升高[OR值(95%CI)=1.421(1.209,1.670),P<0.001]是PAPS患者并发脑梗死的危险因素。结论脑梗死组患者再发血栓的风险可能更高,TIA、aPL三阳性、aGAPSS评分升高是PAPS患者并发脑梗死的危险因素。Objective To analyze the clinical manifestations,risk factors and risk of recurrence in patients with primary antiphospholipid syndrome(PAPS)complicated with cerebral infarction.Methods Inpatients diagnosed with PAPS was recruited between 2010 and 2020.Clinical characteristics,laboratory results and adjusted global antiphospholipid syndrome score(aGAPSS)were compared between patients with cerebral infarction and without cerebral infarction byχ^(2) test,t test or Mann-Whitney U test.Univariate and multivariate Logistic analysis were performed to identify the risk factors associated with cerebral infarction.Results In 145 PAPS patients[median age 44.0(34.0,51.5)years,66.2%female],46(31.7%)patients had cerebral infarction.Patients with cerebral infarction had higher rates of transient ischemic attack(TIA)(50.0%and 20.2%,χ^(2)=13.37,P<0.001),cardiac valvular anomalies(32.6%and 11.1%,χ^(2)=9.86,P=0.002),lupus anticoagulant(LA)(87.0%and 42.4%,χ^(2)=25.35,P<0.001)and triple antiphospholipid antibodies(aPL)positivity(50.0%and 11.1%,χ^(2)=26.64,P<0.001).The aGAPSS value was significantly higher in patients with cerebral infarction compared to those without[13(11,14)and 9(7,13),U=934.50,P<0.001].The independent risk factors for PAPS-associated cerebral infarction were TIA[OR(95%CI)=3.612(1.387,9.403),P=0.009]、triple aPL positivity[OR(95%CI)=8.904(3.169,25.019),P<0.001],higher aGAPSS[OR(95%CI)=1.421(1.209,1.670),P<0.001].Conclusion Patients with cerebral infarction may have a higher risk of thrombus recurrence.TIA,triple aPL positivity and higher aGAPSS are independent risk factors for PAPS patients with cerebral infarction.

关 键 词：抗磷脂综合征 脑梗死 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R593.2[医药卫生—临床医学]