原发性抗磷脂综合征脑卒中:19例回顾性分析

摘要

目的 分析原发性抗磷脂综合征(antiphospholipid syndrome,APS)并发脑卒中患者的临床特点.方法 回顾性分析首都医科大学宣武医院2008年1月至2016年4月原发性APS并发脑卒中19例患者的临床、实验室指标、影像学表现及治疗.结果 19例患者,男∶女为11∶8,均为缺血性脑卒中.并发常见血管病危险因素依次为高血压、高脂血症、吸烟史、动脉粥样硬化症等.5例(5/19)有心脏瓣膜结构改变伴钙化.抗心磷脂抗体(anticardiophospholipid antibody,aCL)阳性率57.9%;抗β2-糖蛋白1(β2-glycoprotein 1,β2-GP1)阳性率78.95%.抗β2-GP1单阳性36.8%,双抗体阳性率42.1%.大脑中动脉是最常累及的颅内/外动脉(11/19),其次是颈(内)动脉(9/19).大动脉管腔不同程度狭窄(11/19)、闭塞(7/19).颈动脉内膜增厚伴斑块形成(6/19).结论 原发性APS并发脑卒中患者多合并一种或多种常见血管病危险因素.抗β2-GP1阳性率更高.对原发性APS患者常规行经食管超声心动图、颈动脉血管超声检查,有利于早期评估脑卒中风险.%Objective To access the clinical characteristics of patients with stroke in primary antiphospholipid syndrome(APS).Methods We analyzed retrospectively 19 cases admitted at Capital Medical University Xuanwu Hospital during 2008-2016.Results The 19 patients (male∶female=11∶8) were all diagnosed of ischemic stroke.The most common vascular risk factors were hypertension, hyperlipidemia, smoking history, and atherosclerosis.Five patients (5/19) had cardiac valvular lesions with calcification.57.9% of patients were aCL(+), with 78.95% were anti-β2-GP1(+).36.8% were anti-β2-GP1 positive only.aCL+ and anti-β2-GP1+ was detected in 42.1%.Middle cerebral artery was the most frequently involved cerebral vessel (11/19), second to which was carotid artery (especially ICA).There were different levels of artery lumen stenosis(11/19), lumen occlusion(7/19), and carotid arterial intima-media thickness with plaque formation(6/19).Conclusions Patients with stroke in primary APS usually have one or more common vascular risk factors.The rate of anti-β2-GP1(+) in these patients is remarkable.It is highly recommended that patients with primary APS should be accessed routinely with transesophageal echocardiography and carotid Doppler ultrasonography to identify the risk of stroke at early stage.