Janardhan Vallabh, Wolf Philip A, Kase Carlos S, Massaro Joseph M, D'Agostino Ralph B, Franzblau Carl, Wilson Peter W F
Department of Neurology, Boston University, Boston, Mass, USA.
Stroke. 2004 Mar;35(3):736-41. doi: 10.1161/01.STR.0000117575.48205.2D. Epub 2004 Feb 5.
The role of anticardiolipin antibodies (aCLs) as novel risk factors for ischemic stroke and transient ischemic attacks (TIAs) has been a matter of debate. Prior cohort studies included only selected subjects, mostly men. We related serum concentrations of aCLs to incident first ischemic stroke/TIA among men and women in the Framingham Heart Study cohort and offspring.
There were a total of 2712 women (mean age, 59.3 years) and 2262 men (mean age, 58.3 years) free of stroke/TIA at the time of their baseline examinations. An enzyme immunoassay was used to measure aCLs. Optical density of the sample serum compared with the reference serum was defined as the aCL screening ratio (aCL SR). Analyses were based on sex-specific aCL SR quartiles and individual ratios.
During the 11-year follow-up, 222 ischemic strokes/TIAs occurred. In multivariate analysis, after adjustment for age, prior cardiovascular disease, systolic blood pressure, diabetes, smoking, C-reactive protein, and total and high-density lipoprotein cholesterol levels, an aCL SR of >0.4 (78% of sample) was significantly associated with an increased risk of ischemic stroke/TIA for women (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.3 to 5.4; absolute risk, 3.2%, 95% CI, 2.2 to 4.3) but not in men (HR, 1.3; 95% CI, 0.7 to 2.4; absolute risk, 4.5%; 95% CI, 3.0 to 6.0). Similar results were obtained when the higher 3 aCL SR quartiles were compared with the lowest.
Elevated serum concentrations of aCLs, independently of other cardiovascular risk factors, significantly predict the risk of future ischemic stroke and TIA in women but not in men.
抗心磷脂抗体（aCLs）作为缺血性卒中及短暂性脑缺血发作（TIAs）的新型危险因素，其作用一直存在争议。既往队列研究仅纳入特定人群，多数为男性。我们在弗雷明汉心脏研究队列及其后代中，探讨了aCLs血清浓度与首次发生缺血性卒中/TIA的关系，涉及男性和女性。
共有2712名女性（平均年龄59.3岁）和2262名男性（平均年龄58.3岁）在基线检查时无卒中/TIA。采用酶免疫测定法检测aCLs。样本血清与参考血清的光密度之比定义为aCL筛查率（aCL SR）。分析基于性别特异性的aCL SR四分位数和个体比率。
在11年的随访期间，发生了222例缺血性卒中/TIA。在多变量分析中，调整年龄、既往心血管疾病、收缩压、糖尿病、吸烟、C反应蛋白以及总胆固醇和高密度脂蛋白胆固醇水平后，aCL SR>0.4（占样本的78%）与女性缺血性卒中/TIA风险增加显著相关（风险比[HR]，2.6；95%置信区间[CI]，1.3至5.4；绝对风险，3.2%，95%CI，2.2至4.3），但与男性无关（HR，1.3；95%CI，0.7至2.4；绝对风险，4.5%；95%CI，3.0至6.0）。将较高的3个aCL SR四分位数与最低四分位数进行比较时，得到了类似结果。
血清aCLs浓度升高，独立于其他心血管危险因素，显著预测女性未来缺血性卒中和TIA的风险，但对男性无此作用。
