Ginsburg K S, Liang M H, Newcomer L, Goldhaber S Z, Schur P H, Hennekens C H, Stampfer M J
Department of Rheumatology and Immunology, Brigham and Women's Hospital, Boston, MA 02115.
Ann Intern Med. 1992 Dec 15;117(12):997-1002. doi: 10.7326/0003-4819-117-12-997.
To determine whether the presence of anticardiolipin antibodies is a risk factor for ischemic stroke and venous thrombosis in healthy adult men.
A nested, case-control study in a prospective cohort.
A nationwide study of physicians.
The study sample was drawn from the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in 22,071 male physicians. At entry, 68% of the participants submitted plasma samples that were subsequently frozen at -80 degrees C. During 60.2 months of follow-up, follow-up for nonfatal outcomes was 99.7% complete and ascertainment of fatal outcomes was 100% complete. We identified men with documented ischemic stroke, deep venous thrombosis of the leg, or pulmonary embolus and for whom a plasma sample was available. A control was matched by age, smoking history, and length of follow-up to each of the 100 patients with ischemic stroke and the 90 patients with deep venous thrombosis or pulmonary embolus.
Plasma samples were assessed for IgG anticardiolipin antibodies by enzyme-linked immunosorbent assay. The mean anticardiolipin antibody titers of the case patients in the two diagnostic groups (ischemic stroke; venous thrombosis or pulmonary embolus) were compared with those of the control groups, and relative risks were calculated for patients in increasing percentile categories of anticardiolipin antibodies by conditional logistic regression.
The anticardiolipin antibody titers were higher in case patients with deep venous thrombosis and pulmonary embolus than in their matched controls (P = 0.01). Persons with anticardiolipin antibody titers above the 95th percentile had a relative risk for developing deep venous thrombosis or pulmonary embolus of 5.3 (95% CI, 1.55 to 18.3; P = 0.01). The anticardiolipin antibody titers in case patients with ischemic stroke and controls were not significantly different (P > 0.2), and no clear trend of higher risks among those with elevated levels of anticardiolipin antibodies was observed.
An anticardiolipin antibody level above the 95th percentile is an important risk factor for deep venous thrombosis or pulmonary embolus but not for ischemic stroke in healthy adult men.
确定抗心磷脂抗体的存在是否为健康成年男性发生缺血性卒中及静脉血栓形成的危险因素。
在前瞻性队列中进行的巢式病例对照研究。
一项针对医生的全国性研究。
研究样本取自医生健康研究，这是一项在22071名男性医生中进行的关于阿司匹林和β-胡萝卜素的随机、双盲、安慰剂对照试验。在入组时，68%的参与者提交了血浆样本，随后样本在-80℃下冷冻保存。在60.2个月的随访期间，非致命结局的随访完成率为99.7%，致命结局的确定率为100%。我们确定了有缺血性卒中、下肢深静脉血栓形成或肺栓塞记录且有血浆样本的男性。为100例缺血性卒中患者及90例深静脉血栓形成或肺栓塞患者中的每一位匹配一名年龄、吸烟史及随访时间与之相同的对照者。
采用酶联免疫吸附测定法评估血浆样本中的IgG抗心磷脂抗体。比较两个诊断组（缺血性卒中；静脉血栓形成或肺栓塞）病例患者的平均抗心磷脂抗体滴度与对照组的平均抗心磷脂抗体滴度，并通过条件逻辑回归计算抗心磷脂抗体百分位数升高的患者的相对风险。
深静脉血栓形成和肺栓塞病例患者的抗心磷脂抗体滴度高于其匹配的对照组（P = 0.01）。抗心磷脂抗体滴度高于第95百分位数的人发生深静脉血栓形成或肺栓塞的相对风险为5.3（95%可信区间，1.55至18.3；P = 0.01）。缺血性卒中病例患者与对照组的抗心磷脂抗体滴度无显著差异（P > 0.2），且未观察到抗心磷脂抗体水平升高者中风险升高的明显趋势。
抗心磷脂抗体水平高于第95百分位数是健康成年男性发生深静脉血栓形成或肺栓塞的重要危险因素，但不是缺血性卒中的危险因素。
