抗心磷脂抗体阳性脑梗塞二级防治研究

A study of the secondary prevention and therapy of cerebral infarction with positive-anticardiolipin antibody

目的探讨小剂量、短疗程、个体化的免疫抑制及抗凝疗法在抗心磷脂抗体(anticardiolipin antibody,ACL)阳性脑梗塞二级防治中的有效性和安全性。方法采用标准对照研究方法随访观察标准组(即单纯阿司匹林治疗组,共27例)、对照1组(即阿司匹林联合激素治疗组,共31例)及对照2组(即阿司匹林联合激素及肝素钠治疗组,共34例)三组脑梗塞的再发事件,分析小剂量、短疗程、个体化的免疫抑制及抗凝疗法在ACL阳性脑梗塞二级防治中的有效性及安全性。结果在治疗后3年随防观察期内,标准组再发缺血性脑卒中(包括短暂性脑缺血发作和再发脑梗塞)再发事件发生率为37.04%(10/27),明显高于对照1组[6.45%(2/31)]和对照2组[2.94%(1/34)],P<0.01。三组均未见脑出血再发。结论小剂量、短疗程、个体化的免疫抑制和抗凝疗法对ACL阳性脑梗塞患者再发事件中的二级防治有效且安全。

Objective To outline the efficacy and safety of the secondary prevention and therapy with lowdose, short- course and individualized immunosuppressors and anticoagulants for cerebral infarction （CI） patients with positive-anticardiolipin antibody （ACL）. Methods This study, including criterion group （namely group accepting therapeusis with aspirin, n = 27）, control 1 （namely group accepting therapeusis with aspirin plus prednisone, n = 31）, and control 2 （namely group accepting therapeusis with aspirin plus prednisone and heparin, n = 34）, was carried out by means of analyzing recurrent events such as transient ischemic attack （TIA）, recurrent CI （RCI）, recurrent cerebral ischemic apoplexy （RCIA）, and cerebral hemorrhage （CH） during the follow- up observation after treatment for cerebral infarction cases with positive- ACL. Results During 3 - year follow- up after treatment of all participants, the incidence of RCIA consisting of TIA and RCI in criterion group was 37.04 % （10/ 27）, which was significantly higher than that in control 1 with 6.45% （2/31） and control 2 with 2.94% （1/34）, P 〈0.01, while no patients of all three groups suffered with CH. Conclusion These results suggest that it is effective and safe for the secondary prevention and therapy with low-dose, short- course and individualized immuno- suppressors and anticoagulants for patients with CI associated with positive-ACL.