Louise Coote Lupus Unit, Counting House, Guy's Hospital.
Radiology Department, St Thomas' Hospital, London, UK.
Rheumatology (Oxford). 2022 Feb 2;61(2):658-666. doi: 10.1093/rheumatology/keab400.
Case reports and small case series suggest that stenotic lesions of the renal, coeliac and mesenteric arteries may occur in the antiphospholipid syndrome (APS) resulting in clinical consequences such as hypertension and abdominal angina. The objective was to determine the prevalence of stenotic lesions in arteries arising from the middle aorta in patients with antiphospholipid antibodies (aPL) compared with healthy, hypertensive and atherosclerotic controls.
In a cross-sectional comparative radiological study using magnetic resonance angiography (MRA), we assessed five groups of subjects for the prevalence of stenotic lesions in arteries arising from the middle aorta: APS/aPL positive, healthy renal donors, patients with hypertension, patients with atherosclerosis defined radiologically and patients with systemic lupus erythematosus and vasculitis who were negative for aPL. All subjects underwent MRA in suspended respiration and images were assessed by two senior radiologists blinded to the clinical details.
In the atherosclerosis group, vascular stenotic lesions were more prevalent (71%) than in any other group (P ≤0.000002). The prevalence of all stenotic lesions in aPL positive patients (33%) was significantly higher than in the renal donors (18%) and hypertensive patients (19%) (P ≤0.009). Renal artery stenosis was significantly more prevalent in aPL positive patients than in renal donors (P ≤0.0006) but similar to the prevalence in hypertensive patients. Coeliac and/or mesenteric lesions were significantly more common in aPL positive patients vs hypertensive patients (P ≤0.001). Stenoses did not correlate with traditional risk factors.
Arterial stenotic lesions in arteries arising from the middle aorta were highly prevalent in atherosclerotic subjects and were more common in aPL-positive patients than in hypertensive patients and healthy renal donors.
病例报告和小病例系列研究表明，抗磷脂综合征（APS）中可能会出现肾动脉、腹腔动脉和肠系膜动脉狭窄病变，导致高血压和腹痛等临床后果。本研究旨在确定与健康人群、高血压人群和动脉粥样硬化人群相比，抗磷脂抗体（aPL）阳性的 APS 患者的主动脉中段分支动脉狭窄病变的发生率。
采用磁共振血管造影（MRA）进行横断面对比放射学研究，我们评估了五组人群中主动脉中段分支动脉狭窄病变的发生率：aPL 阳性的 APS 患者、健康的肾供体、高血压患者、影像学定义的动脉粥样硬化患者和系统性红斑狼疮和血管炎且 aPL 阴性的患者。所有患者均在屏气状态下接受 MRA 检查，由两名资深放射科医生对图像进行评估，评估过程中不了解临床细节。
在动脉粥样硬化组，血管狭窄病变的发生率（71%）高于其他任何组（P ≤0.000002）。aPL 阳性患者所有狭窄病变的发生率（33%）显著高于肾供体（18%）和高血压患者（19%）（P ≤0.009）。aPL 阳性患者的肾动脉狭窄发生率显著高于肾供体（P ≤0.0006），但与高血压患者相似。aPL 阳性患者的腹腔动脉和/或肠系膜病变发生率显著高于高血压患者（P ≤0.001）。狭窄病变与传统危险因素无关。
在动脉粥样硬化患者中，主动脉中段分支动脉的狭窄病变发生率较高，aPL 阳性患者比高血压患者和健康肾供体更常见。
