Pyo Jung Yoon, Jung Seung Min, Lee Sang Won, Song Jason Jungsik, Lee Soo Kon, Park Yong Beom
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2017 Nov;58(6):1128-1134. doi: 10.3349/ymj.2017.58.6.1128.
International consensus criteria for antiphospholipid syndrome (APS) require persistently positive antiphospholipid antibodies (aPL) and medium or high titers in association with clinical manifestations. However, the clinical relevance of persistence and titers of aPL in patients with stroke has not been identified. We aimed to investigate the risk of subsequent thrombotic events in patients with ischemic stroke with aPL positivity in terms of aPL status.
We reviewed the medical records of 99 patients with ischemic stroke with at least one or more aPL-positivity (i.e., positivity for aCL, anti-β2-glycoprotein-1, and/or lupus anticoagulants). The patients were divided into two groups: "definite APS" who fulfilled the laboratory criteria and "indefinite APS" who fell short of the criteria. We compared the risk of subsequent thrombotic events between the two groups. Cox proportional hazards model and Kaplan-Meier survival curves were used for the analyses.
Of the 99 patients, 46 (46%) were classified as having definite APS and 53 (54%) as having indefinite APS. The mean follow-up was 51.6 months. Overall event numbers were 14 (30.4%) in definite APS and 16 (30.2%) in indefinite APS. Increased subsequent thrombotic events (hazard ratio 1.039; 95% confidence interval 0.449-2.404; p=0.930) and decreased time to thrombotic events (log-rank p=0.321) were not associated with aPL status.
There was no increased risk of subsequent thrombotic events in ischemic stroke patients with definite APS, compared with those with indefinite APS.
抗磷脂综合征（APS）的国际共识标准要求抗磷脂抗体（aPL）持续阳性且滴度为中或高，并伴有临床表现。然而，aPL的持续性和滴度在卒中患者中的临床相关性尚未明确。我们旨在根据aPL状态研究缺血性卒中伴aPL阳性患者发生后续血栓事件的风险。
我们回顾了99例缺血性卒中患者的病历，这些患者至少有一种或多种aPL阳性（即抗心磷脂抗体、抗β2糖蛋白1抗体和/或狼疮抗凝物阳性）。患者分为两组：符合实验室标准的“确诊APS”组和未达标准的“未确诊APS”组。我们比较了两组后续血栓事件的风险。采用Cox比例风险模型和Kaplan-Meier生存曲线进行分析。
99例患者中，46例（46%）被分类为确诊APS，53例（54%）为未确诊APS。平均随访时间为51.6个月。确诊APS组的总体事件数为14例（30.4%），未确诊APS组为16例（30.2%）。后续血栓事件增加（风险比1.039；95%置信区间0.449 - 2.404；p = 0.930）和血栓事件发生时间缩短（对数秩检验p = 0.321）与aPL状态无关。
与未确诊APS的缺血性卒中患者相比，确诊APS的患者发生后续血栓事件的风险没有增加。
