血栓性抗磷脂综合征7例回顾性分析

Retrospective analysis of of thrombotic antiphospholipid syndrome:in 7 cases

目的探讨血栓性抗磷脂综合征(antiphospholipid syndrome,APS)的临床表现、实验室检验、神经影像检查、诊治。方法收集2019年1月至2020年11月收治的7例血栓性APS患者的临床资料,对其临床资料、辅助检查、治疗措施及神经影像等进行回顾性分析。结果7例抗磷脂抗体均阳性,血栓累及脑、肾、肺1例,考虑灾难性APS,下肢反复动静脉血栓1例,下肢静脉血栓3例,脑梗死3例。病例中合并系统性红斑狼疮2例,合并强直性脊柱炎1例。予以华法林或利伐沙班抗凝等治疗。因合并结核性脑膜炎去世1例,其余6例症状均得到改善。结论血栓性APS的特点是静脉、动脉或微血管血栓形成,是一类异质性很强的疾病。脑循环是最常受影响的动脉领域,血栓性APS的治疗应该评估血栓的风险,分层治疗。

Objective To explore the clinical manifestation,laboratory examination,neuroimaging examination,diagnosis and treatment of antiphospholipid syndrome(APS).Methods Collecting the clinical data of 7 patients with thrombotic APS from January 2019 throuh November 2020,retrospectively analyzed their clinical data,auxiliary examinations,treatment measures and neuroimaging.Results Seven cases of antiphospholipid antibodies were all positive,1 case of thrombosis involved brain,kidney,lung,considering catastrophic APS,1 case of recurrent arterial and venous thrombosis of lower extremity,3 cases of lower extremity venous thrombosis,3 cases of cerebral infarction.Among the cases,there were 2 cases of systemic lupus erythematosus and 1 case of ankylosing spondylitis.The treatment was treated with anticoagulation such as warfarin or rivaroxaban.One patient died of tuberculous meningitis,and the symptoms of the remaining 6 patients improved.Conclusion Thrombotic APS is characterized by venous,arterial or microvascular thrombosis,which is a very heterogeneous disease.Cerebral circulation is the most commonly affected arterial area.The treatment of thrombotic APS should assess the risk of thrombosis and treat it by stratification.