Muñoz-Rodriguez F J, Font J, Cervera R, Reverter J C, Tàssies D, Espinosa G, López-Soto A, Carmona F, Balasch J, Ordinas A, Ingelmo M
Department of Hemotherapy and Hemostasis, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain.
Semin Arthritis Rheum. 1999 Dec;29(3):182-90. doi: 10.1016/s0049-0172(99)80029-8.
To study the clinical characteristics at diagnosis and during follow-up of patients with the antiphospholipid syndrome (APS) and to analyze the influence of treatment on their outcome.
One hundred patients with APS were included (86% female and 14% male; mean age, 36 years). Sixty-two percent had primary APS and 38% had APS associated with systemic lupus erythematosus (SLE). The median length of follow-up was 49 months.
Fifty-three percent of the patients had thromboses, 52% had thrombocytopenia, and 60% of the women had pregnancy losses. Patients with APS associated with SLE had a higher prevalence of hemolytic anemia (P = .02), thrombocytopenia (platelet count lower than 100 x 10(9)/L) (P = .004), antinuclear antibodies (P = .0002), and low complement levels. Fifty-three percent of the patients with thrombosis had recurrent episodes (86% in the same site as the previous thrombotic event). Recurrences were observed in 19% of the episodes treated with long-term oral anticoagulation, in 42% treated prophylactically with aspirin, and in 91% in which anticoagulant/antiaggregant treatment was discontinued (P = .0007). Multivariate analysis showed that prophylactic treatment and older age had an independent predictive value for rethrombosis. Prophylactic treatment during pregnancy (usually with aspirin) increased the live birth rate from 38% to 72% (P = .0002).
Patients with APS have a high risk of recurrent thromboses. Long-term oral anticoagulation seems to be the best prophylactic treatment to prevent recurrences. Prophylactic treatment with aspirin during pregnancy reduced the rate of miscarriages remarkably.
研究抗磷脂综合征（APS）患者诊断时及随访期间的临床特征，并分析治疗对其预后的影响。
纳入100例APS患者（女性占86%，男性占14%；平均年龄36岁）。62%为原发性APS，38%为与系统性红斑狼疮（SLE）相关的APS。随访时间中位数为49个月。
53%的患者发生过血栓形成，52%有血小板减少，60%的女性有妊娠丢失。与SLE相关的APS患者溶血性贫血（P = 0.02）、血小板减少（血小板计数低于100×10⁹/L）（P = 0.004）、抗核抗体（P = 0.0002）及补体水平降低的患病率更高。53%发生过血栓形成的患者有复发（86%发生在与先前血栓形成事件相同的部位）。在接受长期口服抗凝治疗的发作中，复发率为19%；在接受阿司匹林预防性治疗的发作中，复发率为42%；在停用抗凝/抗聚集治疗的发作中，复发率为91%（P = 0.0007）。多因素分析显示，预防性治疗和年龄较大对再次血栓形成有独立预测价值。孕期预防性治疗（通常使用阿司匹林）使活产率从38%提高到72%（P = 0.0002）。
APS患者有较高的复发性血栓形成风险。长期口服抗凝似乎是预防复发的最佳预防性治疗。孕期使用阿司匹林预防性治疗显著降低了流产率。
