原发性抗磷脂综合征107例临床特点及血栓事件危险因素分析

The clinical manifestations and thrombotic risk factors in primary antiphospholipid syndrome

目的 通过分析原发性抗磷脂综合征（APS）的临床特点,探讨原发性APS患者血栓栓塞事件的高危因素.方法 回顾性分析北京协和医院2004年1-12月住院治疗107例原发性APS患者的临床资料,包括临床表现、实验室检查、血栓形成部位,单因素和多因素logistic回归分析筛选静脉血栓事件和动脉血栓事件的危险因素.结果 72例（67.3％）患者出现静脉血栓事件,29例（27.1％）患者出现动脉血栓事件.静脉血栓事件最常见为深静脉血栓38例（35.5％）,其次为肺血栓栓塞症32例（29.9％）,颅内静脉窦血栓形成9例（8.4％）.动脉血栓事件为短暂性脑缺血发作或缺血性卒中15例（14.0％）,下肢动脉栓塞7例（6.5％）,急性心肌梗死4例（3.7％）.67例（62.6％）患者狼疮抗凝物阳性,60例（56.1％）患者抗心磷脂抗体阳性,32例（29.9％,32/74）患者抗β2糖蛋白I （β2GP I）抗体阳性.40例（37.4％）患者2个抗体（狼疮抗凝物和抗心磷脂抗体、狼疮抗凝物和抗β2GP I抗体、抗心磷脂抗体和抗β2GP I抗体）阳性,19例（17.8％）患者3个抗体（狼疮抗凝物、抗心磷脂抗体、抗β2GP I抗体）阳性.logistic回归分析显示,年龄（每增长10岁）（OR值为1.421,95％ CI 1.066～1.894,P＜0.05）、低补体血症（OR值为6.435,95％CI 1.374～30.130,P＜0.05）是原发性APS患者出现静脉血栓事件的高危因素.吸烟（OR值3.996,95％CI 1.079～14.795,P＜0.05）、3个抗体阳性（OR值为3.166,95％ CI 1.102～9.097,P＜0.05）是原发性APS出现动脉血栓事件的高危因素.结论 下肢深静脉血栓形成、肺栓塞、缺血性卒中/短暂性脑缺血发作是原发性APS最常见的静脉和动脉血栓事件;高龄、补体降低是原发性APS患者出现静脉血栓事件的高危因素,吸烟、3个抗体阳性是动脉血栓事件高危因素.

Objective To investigate the clinical characteristics in patients with primary antiphospholipid syndrome （PAPS） and to identify potential predictors of thrombotic events.Methods A total of 107 patients with PAPS were enrolled in our study, who were admitted in Peking Union Medical College Hospital from January 2004 to December 2014.Demographic data, age at onset, disease duration, past history of hypertension and regular cigarette smoking, clinical manifestations, imaging characteristics, management and prognosis were retrospectively collected.Bivariate statistical analysis and logistical regression test were performed to compare the discrepancy between patients with or without thromboembolic events.Results In 107 patients, there were 65 female and 42 male patients, with mean age （39.8 ± 15.8） years old, median disease duration 10.5 （2.0, 48.0） months.A total of 72（67.3％） patients reported episodes of thromboembolic events, including 72 venous thromboses and 29 arterial thromboses.The most frequent venous thromboses were deep vein thromboses （35.5％）, pulmonary embolism the second common （29.9％）, with cranial venous sinus thromboses the following （8.4％）.In arterial thromboembolic events, the incidence of transient ischemic attack （TIA） and ischemic stoke was the highest （14.0％）, embolism of lower extremities the second （6.5％） ,and 4 patients （3.7％） with acute myocardial infarction.Sixty seven patients （62.6％）had positive lupus anticoagulant, 60 patients （56.1％）with positive anticardiolipin antibody,32 patients （29.9％, 32/74） with positive β2 glycoprotein Ⅰ （β2GP I）.Forty patients（37.4％）had double positive antibodies, while 19 cases （17.8％）with triple positive.In logistical regression, aging （per 10 years） and hypocomplementemia were significantly related to venous thrombosis （OR =1.421, 95％ CI 1.066-1.894, P ＜ 0.05, and OR =6.435, 95％ CI 1.374-30.130, P ＜ 0.05, respectively）.Cigarette smoking and triple positive antibodies were independent risk factors of arterial thrombosis （OR =3.996, 95％ CI 1.079-14.795, P ＜ 0.05 and OR =3.166, 95％ CI 1.102-9.097, P ＜ 0.05, respectively）.Conclusion Alas is an autoimmune disorder characterized by recurrent arterial and venous thromboembolic events.Venous thromboembolism is more common than the arterial.Age and hypocomplementemia are predictors of venous thromboembolism;while smoking and triple positive antibodies are independent risk factors of arterial thromboembolism.