Kitagawa Y, Gotoh F, Koto A, Okayasu H
Department of Neurology, Kawasaki Municipal Hospital, Japan.
Stroke. 1990 Nov;21(11):1533-9. doi: 10.1161/01.str.21.11.1533.
We investigated the clinical and pathologic characteristics of stroke in 234 patients with systemic lupus erythematosus. Thirteen patients (5.6%) developed cerebrovascular disease. Cerebral infarction was noted in eight, cerebral hemorrhage in two, and subarachnoid hemorrhage in three. In seven (54%) of these 13 patients, stroke occurred less than or equal to 5 years after systemic lupus erythematosus was diagnosed. Among the predisposing risk factors for stroke, hypertension was the most important. Lupus anticoagulant was detected in three (38%) and anticardiolipin antibody in three (43% of seven investigated) of the patients with infarction. Evaluation of the clinical manifestations and autoantibodies indicated that renal involvement and high titers of anti-deoxyribonucleic acid antibody were more frequent in the stroke group than in the non-stroke group. Autopsy studies on six of the patients with stroke revealed small infarcts and hemorrhages in all, but in no case was true angiitis observed. Libman-Sacks endocarditis was found in two of the three patients with infarction. In conclusion, the important contributory factor to the development of stroke in patients with systemic lupus erythematosus is considered to be hypertension mediated by immunologic abnormalities. Antiphospholipid antibodies and Libman-Sacks endocarditis are closely associated with occlusive cerebrovascular disease.
我们研究了234例系统性红斑狼疮患者中风的临床和病理特征。13例（5.6%）发生了脑血管疾病。其中8例为脑梗死，2例为脑出血，3例为蛛网膜下腔出血。在这13例患者中，7例（54%）在系统性红斑狼疮确诊后5年以内发生中风。在中风的诱发危险因素中，高血压最为重要。在梗死患者中，3例（38%）检测到狼疮抗凝物，3例（所检测的7例中的43%）检测到抗心磷脂抗体。对临床表现和自身抗体的评估表明，中风组肾脏受累及抗脱氧核糖核酸抗体高滴度的情况比非中风组更常见。对6例中风患者的尸检研究显示，所有患者均有小梗死灶和出血，但均未观察到真正的血管炎。在3例梗死患者中的2例发现了Libman-Sacks心内膜炎。总之，系统性红斑狼疮患者中风发生的重要促成因素被认为是由免疫异常介导的高血压。抗磷脂抗体和Libman-Sacks心内膜炎与闭塞性脑血管疾病密切相关。
