Department of Neurology, Myong-Ji St. Mary's Hospital, Seoul, Republic of Korea.
Department of Neurosurgery, Myong-Ji St. Mary's Hospital, Seoul, Republic of Korea.
Medicine (Baltimore). 2024 Sep 27;103(39):e39890. doi: 10.1097/MD.0000000000039890.
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies (aPLA), such as anticardiolipin (aCL), anti-β2-glycoprotein I (aβ2GPI), or lupus anticoagulant (LA). Although cerebrovascular events are commonly associated with APS, comprehensive studies on risk factors for cerebral infarction in aPLA-positive patients remain sparse. In this retrospective single-center study, data from 9844 patients tested for aPLA between January 2017 and March 2023 were analyzed. A total of 647 aPLA-positive patients were included, with assessments of various factors including age, gender, hypertension, diabetes, dyslipidemia, smoking history, and cardiac disease. Propensity score matching was employed to create 2 matched groups of 202 patients each, comparing those with and without cerebral infarction. Logistic regression analyses were conducted to identify risk factors for cerebral infarction and progression of cerebrovascular stenosis. The mean age of the study cohort was 65.8 years, with 60% being male. LA was positive in 95.2% of the cases, aCL in 8.8%, and aβ2GPI in 5.3%. High-risk aPLA profiles were identified in 7.1% of the cases. In the cerebral infarction group, both smoking history and aCL positivity were significantly associated with an increased risk (OR = 1.543; 95% CI: 1.020-2.334; P = .040 and OR = 3.043; 95% CI: 1.426-6.491; P = .040, respectively). Male gender and posterior circulation involvement were significant risk factors for exacerbation of cerebrovascular stenosis (OR = 3.73; 95% CI: 1.16-16.69; P = .046 and OR = 5.41; 95% CI: 1.80-16.05; P = .002, respectively). Smoking history and aCL positivity are prominent risk factors for cerebral infarction in aPLA-positive patients, while male gender and involvement of the posterior circulation emerge as significant risk factors for the progression of cerebrovascular stenosis. Further comprehensive prospective studies are necessary to deepen understanding of aPLA-related cerebrovascular diseases.
抗磷脂综合征（APS）是一种自身免疫性疾病，其特征是存在抗磷脂抗体（aPLA），如抗心磷脂（aCL）、抗β2-糖蛋白 I（aβ2GPI）或狼疮抗凝物（LA）。尽管脑血管事件通常与 APS 相关，但针对 aPLA 阳性患者脑梗死危险因素的综合研究仍然很少。在这项回顾性单中心研究中，分析了 2017 年 1 月至 2023 年 3 月期间检测 aPLA 的 9844 名患者的数据。共纳入 647 名 aPLA 阳性患者，评估了年龄、性别、高血压、糖尿病、血脂异常、吸烟史和心脏病等各种因素。采用倾向评分匹配创建了 2 个各包含 202 名患者的匹配组，比较有和无脑梗死的患者。进行 logistic 回归分析以确定脑梗死和脑血管狭窄进展的危险因素。研究队列的平均年龄为 65.8 岁，其中 60%为男性。95.2%的病例 LA 阳性，8.8%的病例 aCL 阳性，5.3%的病例 aβ2GPI 阳性。7.1%的病例存在高危 aPLA 谱。在脑梗死组中，吸烟史和 aCL 阳性均与风险增加显著相关（OR=1.543；95%CI：1.020-2.334；P=0.040 和 OR=3.043；95%CI：1.426-6.491；P=0.040）。男性和后循环受累是脑血管狭窄恶化的显著危险因素（OR=3.73；95%CI：1.16-16.69；P=0.046 和 OR=5.41；95%CI：1.80-16.05；P=0.002）。吸烟史和 aCL 阳性是 aPLA 阳性患者脑梗死的显著危险因素，而男性和后循环受累是脑血管狭窄进展的显著危险因素。需要进一步开展全面的前瞻性研究，以加深对 aPLA 相关脑血管疾病的认识。
