Institute of Cardio-Vascular Diseases, Clinical Center of Serbia, Belgrade, Serbia.
Internal Medicine, "Bezanijska Kosa", University Medical Center, Belgrade, Serbia.
Immunol Res. 2017 Dec;65(6):1150-1155. doi: 10.1007/s12026-017-8968-1.
Antiphospholipid syndrome (APS) is an autoimmune disease defined by accelerated atherosclerosis, arterial and venous thrombosis, fetal loss, and the presence of antiphospholipid antibodies (aPL) in the serum and which leads to the occurrence of various vascular events. Nonspecific abdominal pain can be one of the symptoms due to changes on visceral blood vessels. The goal of our work is to show the results we obtained in multidetector computed tomography (MDCT) angiography examination of visceral arteries, comparing patients with primary antiphospholipid syndrome (PAPS) and secondary antiphospholipid syndrome (SAPS) with control group. In this study, we analyzed 50 patients with primary PAPS and 50 patients, with secondary SAPS. The results were compared to 50 patients in the control group. The groups were compared in terms of age, gender, and the most common risk factors except for the lipid status, since controls had significantly higher levels of cholesterol and triglycerides. The study was conducted on 64-MDCT, on which we analyzed quantitative and morphological characteristics of the blood vessel lesions. Patients from the control group had statistically significant elevation of cholesterol and triglyceride levels compared to the patients with SAPS and PAPS (p < 0.001 and p < 0.05). The results showed that the frequency of changes is statistically (p < 0.05 and p < 0.001) more common in patients with PAPS and SAPS than in the control group. Statistically significant difference between the groups was found in superior and inferior mesentery arteries. Analyzing the number of lesions, there was statistically high difference between the patients with one and two lesions than in patients with four or more lesions (p < 0.001), lower difference compared to the patients with three lesions (p < 0.01), while there was low, but yet statistically important difference between the patients with three lesions and those with five or more blood vessel lesions (p < 0.05). Analyzing percentage of diameter stenosis, we established that the lesions in the groups of 0-30% diameter stenosis (DS) and 30-50% DS in patients with PAPS (n = 42) and SAPS (n = 44) are more common than in the control group (n = 18, p < 0.05). Analyzing the qualitative characteristics of plaques, we established significantly higher frequency of soft tissue and mixed lesions than calcified ones in patients with PAPS and SAPS (p < 0.001; p < 0.05). Our study showed that the subclinical manifestation of the changes on visceral arteries is more common in patients with APS. Patients with abdominal pain were those with two or more lesions, and according to our results, majority had PAPS. Because of its safety and accuracy, the method of choice is MDCT angiography in monitoring the progression of disease.
抗磷脂综合征（APS）是一种自身免疫性疾病，其特征为动脉粥样硬化加速、动静脉血栓形成、胎儿丢失以及血清中存在抗磷脂抗体（aPL），从而导致各种血管事件的发生。非特异性腹痛可能是由于内脏血管变化引起的症状之一。我们的工作目标是展示在多排螺旋 CT（MDCT）血管造影检查内脏动脉时，原发性抗磷脂综合征（PAPS）和继发性抗磷脂综合征（SAPS）患者与对照组之间的结果。在这项研究中，我们分析了 50 例原发性 PAPS 患者和 50 例继发性 SAPS 患者，并将结果与 50 例对照组患者进行比较。除血脂状况外，还比较了各组的年龄、性别和最常见的危险因素，因为对照组的胆固醇和甘油三酯水平明显更高。该研究在 64 层 MDCT 上进行，我们分析了血管病变的定量和形态特征。与 SAPS 和 PAPS 患者相比，对照组患者的胆固醇和甘油三酯水平具有统计学显著升高（p < 0.001 和 p < 0.05）。结果表明，与对照组相比，PAPS 和 SAPS 患者的变化频率更高，具有统计学意义（p < 0.05 和 p < 0.001）。肠系膜上动脉和肠系膜下动脉之间存在统计学显著差异。分析病变数量时，与有 4 个或更多病变的患者相比，有 1 个和 2 个病变的患者存在统计学显著差异（p < 0.001），与有 3 个病变的患者相比差异较小（p < 0.01），而与有 3 个病变的患者相比，有 5 个或更多血管病变的患者差异较小（p < 0.05）。分析直径狭窄百分比时，我们发现 PAPS（n = 42）和 SAPS（n = 44）患者 0-30% 直径狭窄（DS）和 30-50% DS 组的病变比对照组（n = 18）更常见（p < 0.05）。分析斑块的定性特征时，我们发现 PAPS 和 SAPS 患者的软组织和混合病变的频率明显高于钙化病变（p < 0.001；p < 0.05）。我们的研究表明，APS 患者内脏动脉的亚临床表现更为常见。腹痛患者为有 2 个或更多病变的患者，根据我们的结果，大多数为 PAPS。由于其安全性和准确性，MDCT 血管造影是监测疾病进展的首选方法。
