Wang Qiqi, Han Guangsong, Sha Yuhui, Tang Mingyu, Pan Ziang, Zhu Yicheng, Zhou Lixin, Ni Jun
Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Neurol Sci. 2024 Mar;45(3):1121-1128. doi: 10.1007/s10072-023-07054-7. Epub 2023 Sep 14.
Testing for antiphospholipid antibodies (aPL) is useful to determine the cause of ischemic stroke in young and female patients. However, the clinical relevance of aPL in older patients with ischemic stroke remains unclear. We aimed to explore the status and diagnostic value of initial aPL testing in all patients with acute ischemic stroke.
We retrospectively analyzed patients with acute ischemic stroke who were consecutively hospitalized in our hospital between June 2012 and January 2022 and investigated the factors associated with performing aPL screening in real-world clinical practice. Furthermore, factors associated with initial aPL positivity were evaluated by comparing the demographic, etiological, and therapeutic characteristics.
Of 1209 patients, 287 (23.7%) were tested for aPL and 58 (20.2%) tested positive. Physicians tended to conduct aPL testing on female patients (P<0.001), younger patients (P<0.001), patients with fewer vascular risk factors (P<0.001), and multiple infarctions in the multivascular blood supply area (P<0.001). Multivariate logistic regression analysis showed that only stroke of other determined etiology type was a significant influencing factor for positive aPL results (OR 2.97, 95% CI 1.137, 7.774, P=0.026), adjusting for sex, age, and causes of stroke, etc. CONCLUSION: Approximately one-quarter of the patients with acute ischemic stroke were tested for aPL. Age, sex, number of vascular risk factors, and neuroimaging features affected the discretion in performing aPL testing. aPL testing may be appropriate in older patients with no identified cause of ischemic stroke and may provide additional diagnostic opportunities for acute ischemic stroke.
检测抗磷脂抗体（aPL）有助于确定年轻及女性患者缺血性卒中的病因。然而，aPL在老年缺血性卒中患者中的临床相关性仍不明确。我们旨在探讨所有急性缺血性卒中患者首次aPL检测的情况及诊断价值。
我们回顾性分析了2012年6月至2022年1月期间在我院连续住院的急性缺血性卒中患者，并调查了在实际临床实践中进行aPL筛查的相关因素。此外，通过比较人口统计学、病因学和治疗特征，评估与首次aPL阳性相关的因素。
1209例患者中，287例（23.7%）接受了aPL检测，58例（20.2%）检测呈阳性。医生倾向于对女性患者（P<0.001）、年轻患者（P<0.001）、血管危险因素较少的患者（P<0.001）以及多血管供血区域有多处梗死的患者（P<0.001）进行aPL检测。多因素logistic回归分析显示，在调整性别、年龄和卒中病因等因素后，仅其他明确病因类型的卒中是aPL结果阳性的显著影响因素（OR 2.97，95%CI 1.137，7.774，P=0.026）。结论：约四分之一的急性缺血性卒中患者接受了aPL检测。年龄、性别、血管危险因素数量和神经影像学特征影响了aPL检测的决策。aPL检测可能适用于未明确缺血性卒中病因的老年患者，并可能为急性缺血性卒中提供额外的诊断机会。
