Asherson R A, Baguley E, Pal C, Hughes G R
Lupus Arthritis Research Unit, Rayne Institute, St Thomas's Hospital, London.
Ann Rheum Dis. 1991 Nov;50(11):805-10. doi: 10.1136/ard.50.11.805.
Nineteen patients out of 250 subjects with antiphospholipid antibodies, who had initially presented to the lupus clinic at St Thomas's Hospital, London five or more years ago with a history of venous/arterial occlusions, were entered into the study. The patients were divided into two main groups: I those who remained well without any further thromboembolic complications (n = 10); II those who developed recurrent thrombotic events in the five year period (n = 9). The patients were followed up to determine the relation between the level or the isotype of the anticardiolipin antibodies, or both, to the recurrent thromboembolic events, and the effect of a variety of treatments (corticosteroids, immunosuppression, anticoagulation) in the prevention of further vascular occlusions. Lupus activity over the five year period varied considerably between the two groups--those in group I tending to be relatively inactive compared with those in group II. For some patients in group II thromboembolic events seemed to occur at the time of lupus activity. Antiphospholipid antibodies remained positive in all patients, the levels remaining fairly constant. Levels fell in only one patient in group I and in two in group II. Patients in group II had more systemic lupus erythematosus related disease than those in group I; most were receiving concomitant steroid and immunosuppressive therapy, but this did not seem to protect against the development of further occlusions. All patients were given anticoagulation treatment (warfarin/heparin) or salicylates (low dose aspirin 75 mg daily), or both. Patients with deep vein thromboses developed more complications during anticoagulation therapy than those with cerebrovascular symptoms. Problems in anticoagulation control and recurrent thromboses consequent on warfarin withdrawal despite the administration of subcutaneous heparin were responsible for complications in most patients in group II.
在250名抗磷脂抗体阳性的受试者中，有19名患者最初于五年或更久之前因静脉/动脉闭塞病史前往伦敦圣托马斯医院狼疮门诊就诊，他们被纳入该研究。这些患者被分为两个主要组：第一组，那些未出现任何进一步血栓栓塞并发症且病情稳定的患者（n = 10）；第二组，那些在五年期间发生复发性血栓事件的患者（n = 9）。对这些患者进行随访，以确定抗心磷脂抗体水平或亚型或两者与复发性血栓栓塞事件之间的关系，以及各种治疗（皮质类固醇、免疫抑制、抗凝）在预防进一步血管闭塞方面的效果。两组患者在五年期间的狼疮活动情况差异很大——与第二组患者相比，第一组患者的病情相对不活跃。对于第二组中的一些患者，血栓栓塞事件似乎发生在狼疮活动期。所有患者的抗磷脂抗体均保持阳性，水平相当稳定。仅第一组有1名患者、第二组有2名患者的抗体水平下降。第二组患者比第一组患者有更多与系统性红斑狼疮相关的疾病；大多数患者同时接受类固醇和免疫抑制治疗，但这似乎并不能预防进一步的血管闭塞。所有患者均接受抗凝治疗（华法林/肝素）或水杨酸盐（每日低剂量阿司匹林75毫克），或两者兼用。与有脑血管症状的患者相比，深静脉血栓形成患者在抗凝治疗期间出现更多并发症。在大多数第二组患者中，抗凝控制问题以及尽管使用了皮下肝素但停用华法林后仍出现复发性血栓形成是导致并发症的原因。
