Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico City, Mexico.
Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Clin Neurol Neurosurg. 2021 Mar;202:106492. doi: 10.1016/j.clineuro.2021.106492. Epub 2021 Jan 15.
The objective of this study was to identify clinical and laboratory risk factors for ischemic stroke (IS) in primary antiphospholipid syndrome (APS) patients.
We performed a case-control study with consecutive primary APS patients divided into two groups, those who presented with IS, vs. those with no history of stroke. Demographics, vascular risk factors, therapeutic approaches, laboratory, imaging and functional outcomes were recorded.
Fifty-three confirmed primary APS patients with IS and sixty-six non-stroke primary APS controls were recruited. Most patients were female (65.5 %), with a median age of 33 years. The main vascular risk factors for primary APS-associated stroke were hypertension (11.3 %), diabetes (11.3 %) and hypercholesterolemia (9.4 %). Among patients with stroke, median NIHSS score was 6; 15.1 % of these patients presented a recurrent stroke, and 88.8 % had a good functional outcome at the final follow-up. Positive lupus anticoagulant (OR = 6.1, 95 %CI 2.7-13.5), anti-β2 glycoprotein IgG (OR = 3.6, 95 %CI 1.7-7.9), and anticardiolipin IgG (OR = 2.8, 95 %CI 1.3-5.9) were more prevalent in non-stroke primary APS, with a triple-positive antibody presence in 46.4 % of controls vs. 22.2 % of patients with stroke (OR = 3.0, 95 %CI 1.3-6.7). At the time of the index event (arterial or venous), 14 known primary APS patients were using vitamin K antagonists, but only 35.7 % of them had achieved therapeutic INR.
Patients with primary APS and IS have similar vascular risk factors and lower antibody positivity than those with extracranial thrombosis.
本研究旨在确定原发性抗磷脂综合征（APS）患者发生缺血性卒中（IS）的临床和实验室危险因素。
我们进行了一项病例对照研究，纳入了连续的原发性 APS 患者，将其分为发生 IS 组和无卒中史组。记录了患者的人口统计学、血管危险因素、治疗方法、实验室、影像学和功能结局。
共纳入 53 例确诊的原发性 APS 合并 IS 患者和 66 例无卒中的原发性 APS 对照组患者。大多数患者为女性（65.5%），中位年龄为 33 岁。原发性 APS 相关卒中的主要血管危险因素包括高血压（11.3%）、糖尿病（11.3%）和高胆固醇血症（9.4%）。在卒中患者中，NIHSS 评分中位数为 6 分；15.1%的患者出现了复发性卒中，88.8%的患者在最终随访时功能结局良好。狼疮抗凝物阳性（OR=6.1，95%CI 2.7-13.5）、抗β2 糖蛋白 IgG 阳性（OR=3.6，95%CI 1.7-7.9）和抗心磷脂 IgG 阳性（OR=2.8，95%CI 1.3-5.9）在无卒中的原发性 APS 中更为常见，而对照组中三联抗体阳性的比例为 46.4%，卒中组中为 22.2%（OR=3.0，95%CI 1.3-6.7）。在首发事件（动脉或静脉）时，14 例已知原发性 APS 患者正在使用维生素 K 拮抗剂，但只有 35.7%的患者达到了治疗性 INR。
原发性 APS 合并 IS 患者的血管危险因素与发生颅外血栓的患者相似，但抗体阳性率较低。
