抗磷脂综合征误诊为神经精神性狼疮1例并文献复习  

Antiphospholipid syndrome misdiagnosed as neuropsychiatric systemic lupus erythematosus:A case report and literature review

作　　者：张强[1] 余楠楠 张天元[3] 王常明[1] 邓伟哲[1] ZHANG Qiang;YU Nannan;ZHANG Tianyuan(Department of Traditional Chinese Medicine Rheumatology,The 962nd Hospital of Joint Logistics Support Force of Chinese People's Liberation Army,Harbin 150048,China)

机构地区：[1]中国人民解放军联勤保障部队第九六二医院中医风湿科,黑龙江哈尔滨150048 [2]中国人民解放军空军军医大学第一附属医院中医科,陕西西安710032 [3]哈尔滨医科大学附属第四医院神经内科,黑龙江哈尔滨150001

出　　处：《中风与神经疾病杂志》2024年第9期839-842,共4页Journal of Apoplexy and Nervous Diseases

基　　金：黑龙江省医学发展基金项目(2023QY003);陕西省中医药管理局资助类课题(2019-ZZ-JC013)。

摘　　要：抗磷脂综合征和神经精神性狼疮在中枢神经系统受累时,临床症状及辅助检查相似,但诊疗策略不同,容易误诊误治。本文分析误诊原因并文献复习。回顾经中国人民解放军联勤保障部队第九六二医院收治的1例以血小板减少、脑卒中为首发症状的病例,初诊为“神经精神性狼疮”,给予羟氯喹、糖皮质激素及吗替麦考酚酯诱导缓解,并给予阿司匹林抗血小板聚集。后患者出现磷脂抗体谱阳性及静脉血栓形成,修诊为“抗磷脂综合征”,给予羟氯喹及小剂量糖皮质激素维持治疗,并给予低分子肝素抗凝-吲哚布芬抗血小板聚集序贯治疗,随访5个月患者病情稳定未复发。抗磷脂综合征与神经精神性狼疮在首发症状及血栓事件的判断是早期诊断的关键。吲哚布芬作为阿司匹林的替代方案在抗磷脂综合征的远期疗效值得进一步探讨。When antiphospholipid syndrome(APS)and neuropsychiatric systemic lupus erythematosus(NPSLE)involve the central nervous system,the two diseases tend to have similar clinical symptoms and auxiliary examination re-sults and different diagnosis and treatment strategies,which may lead to potential misdiagnosis and mistreatment.This ar-ticle analyzes the causes of misdiagnosis and performs a literature review.A retrospective analysis was performed for one patient with thrombocytopenia and stroke as initial symptoms.The patient was initially diagnosed with NPSLE and was treated with hydroxychloroquine,glucocorticoids,mycophenolate mofetil to induce remission,and aspirin was given to prevent platelet aggregation.Subsequently,the patient developed a positive spectrum of antiphospholipid antibodies and venous thrombosis;therefore,the patient was diagnosed with APS and was given maintenance treatment with hydroxychlo-roquine and low-dose glucocorticoids and sequential therapy with low-molecular-weight heparin as an anticoagulant and in-dobufen for antiplatelet aggregation therapy.The patient had stable conditions without recurrence during follow-up for 5 months.Recognizing the initial symptoms and thrombotic events is crucial for the early diagnosis of APS and NPSLE.Fur-ther studies are needed to explore the long-term efficacy of indobufen as an alternative to aspirin in APS.

关 键 词：抗磷脂综合征 神经精神性狼疮 血小板减少 阿司匹林 吲哚布芬 

分 类 号：R743.32[医药卫生—神经病学与精神病学]