Brey R L, Chapman J, Levine S R, Ruiz-Irastorza G, Derksen R H W M, Khamashta M, Shoenfeld Y
Department of Medicine, Division of Neurology, University of Texas Health Science Center-San Antonio, Texas 78229-3900, USA.
Lupus. 2003;12(7):508-13. doi: 10.1191/0961203303lu390oa.
Ischaemic stroke is the only neurological manifestation accepted as a clinical diagnostic criterion for the antiphospholipid syndrome (APS). This association is reasonably well established in patients first diagnosed with APS but is less clear in randomly selected stroke patients who test positive on one occasion for antiphospholipid antibodies and who have no other evidence of systemic autoimmune disease. We propose a grading system that posits stroke to be definitely, likely or possibly associated with antiphospholipid antibodies (aPL). Further, there are limited prospective data to determine appropriate treatment. There is controversy as to whether the presence of aPL even increases risk of a recurrent stroke or other thromboembolic event, although data point to persistent medium-high titre aCL and/or LA as risk factors for recurrence. In the absence of data to guide clinicians on the best treatment, we cannot make strong recommnendations as to optimal therapy, nor can we propose clear consensus treatment guidelines.
缺血性中风是抗磷脂综合征（APS）唯一被认可的作为临床诊断标准的神经学表现。这种关联在首次诊断为APS的患者中已得到较好的确立，但在随机选择的中风患者中，这种关联不太明确，这些患者一次检测抗磷脂抗体呈阳性且无其他系统性自身免疫性疾病证据。我们提出了一个分级系统，将中风确定为与抗磷脂抗体（aPL）明确、可能或潜在相关。此外，确定适当治疗方法的前瞻性数据有限。关于aPL的存在是否会增加复发性中风或其他血栓栓塞事件的风险存在争议，尽管数据表明持续的中高滴度aCL和/或LA是复发的危险因素。由于缺乏指导临床医生进行最佳治疗的数据，我们无法就最佳治疗方法给出强有力的建议，也无法提出明确的共识治疗指南。
