Mo Ruijie, Zhao Yuan, Jiang Hui, Zhou Yangzhong, Huang Can, Wang Qian, Tian Xinping, Li Mengtao, Zeng Xiaofeng, Zhao Jiuliang
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.
National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing, China.
Adv Ther. 2025 Aug 19. doi: 10.1007/s12325-025-03317-1.
The aim of this study was to evaluate the rate of delayed diagnosis in patients with thrombotic antiphospholipid syndrome (tAPS) and explore potential risk factors and prognosis of delayed diagnosis.
This single-center, prospective study included consecutive patients with tAPS fulfilling the 2006 Sydney Revised Classification Criteria referred to Peking Union Medical College Hospital from June 2012 to September 2022. Patients diagnosed after more than two aPL-related clinical events had occurred were defined as having delayed diagnosis. Logistic regression analysis was used to identify risk factors, and survival analysis was employed to assess prognosis.
A total of 379 patients were enrolled in the study. The mean age was 32.35 ± 13.86 years old, and 221 were female (58.31%), with venous thromboembolism occurring in 174 (45.91%) patients as the first event and arterial thrombosis in 107 (28.23%). Two hundred fifty-four (67.02%) patients had delayed diagnosis. Three high-frequency contributors for delay were obstetric morbidity (39.68%), deep vein thrombosis (26.38%), and thrombocytopenia (19.69%). Multivariate logistic regression indicated that patients with cardiovascular risk factors were more likely to receive delayed diagnosis (odds ratio [OR] = 1.767, 95% confidence interval [CI] 1.129-2.767, P = 0.013). Thrombocytopenia as first events (OR = 2.277, 95% CI 1.159-4.474, P = 0.017) was also a risk factor. Survival analysis showed that APS-related clinical manifestations and thrombotic recurrence were more likely to occur in delayed diagnosis group.
Delayed diagnosis of tAPS is common, which may lead to poor prognosis. For patients with cardiovascular risk factors and non-criteria manifestations, physicians should be alert to the possibility of APS.
本研究旨在评估血栓性抗磷脂综合征（tAPS）患者的延迟诊断率，并探讨延迟诊断的潜在危险因素及预后情况。
本单中心前瞻性研究纳入了2012年6月至2022年9月期间因符合2006年悉尼修订分类标准而转诊至北京协和医院的连续tAPS患者。在发生两例以上与抗磷脂抗体（aPL）相关的临床事件后才被诊断的患者被定义为延迟诊断。采用逻辑回归分析确定危险因素，并采用生存分析评估预后。
本研究共纳入379例患者。平均年龄为32.35±13.86岁，女性221例（58.31%），174例（45.91%）患者首发事件为静脉血栓栓塞，107例（28.23%）为动脉血栓形成。254例（67.02%）患者存在延迟诊断。延迟诊断的三个高频因素为产科并发症（39.68%）、深静脉血栓形成（26.38%）和血小板减少（19.69%）。多因素逻辑回归表明，有心血管危险因素的患者更易接受延迟诊断（比值比[OR]=1.767，95%置信区间[CI]1.129 - 2.767，P = 0.013）。首发血小板减少（OR = 2.277，95% CI 1.159 - 4.474，P = 0.017）也是一个危险因素。生存分析显示，延迟诊断组更易出现APS相关临床表现和血栓复发。
tAPS延迟诊断常见，可能导致预后不良。对于有心血管危险因素及非标准临床表现的患者，医生应警惕APS的可能性。
