Herrick A L, Heaney M, Hollis S, Jayson M I
Rheumatic Diseases Centre, University of Manchester, Hope Hospital, Salford, United Kingdom.
Ann Rheum Dis. 1994 Aug;53(8):540-2. doi: 10.1136/ard.53.8.540.
Following observation of weakly positive anticardiolipin (aCL) antibodies in four of eight patients with systemic sclerosis (SSc) and severe digital ischaemia requiring amputation, the association between the presence of these and other antibodies and severe peripheral ischaemia in patients with SSc was examined.
ACL antibodies (IgG and IgM), anticentromere and anti-Scl-70 antibodies were measured in a further 60 patients with SSc over a one year period. Thirty one of the 68 patients in whom aCL antibodies were assayed had 'severe ischaemia', having suffered digital ischaemia severe enough to warrant amputation (13 patients), surgical debridement or admission for intravenous vasodilator therapy.
There was no difference in aCL positivity between those with severe ischaemia and those without, nor between those who had amputations and those who had not. Three of the 31 patients (10%) with severe ischaemia had IgG and eight (26%) IgM aCL antibodies in weak to moderate titre compared to 10 (27%) and 6 (16%) respectively of the remaining patients (p = 0.06 for IgG and p = 0.25 for IgM, Fisher's exact test). Seventeen of the 31 patients (55%) with severe ischaemia were anticentromere antibody positive compared with nine of 37 (24%) without ischaemia (p = 0.01). Six patients with severe ischaemia had anti-Scl-70 antibodies compared with two of the 37 without ischaemia (p = 0.08).
The findings do not support an association between aCL antibodies and severe ischaemia in SSc, but confirm the previously reported association between anticentromere antibodies and severe peripheral ischaemia. Although anti-Scl-70 antibodies were present only in a small number of patients, there was also a tendency for these to be associated with severe ischaemia, suggesting that patients with either anticentromere or anti-Scl-70 antibodies should be considered at risk of digital loss.
在8例系统性硬化症（SSc）且因严重指端缺血需截肢的患者中，观察到4例抗心磷脂（aCL）抗体弱阳性，因此对这些抗体及其他抗体的存在与SSc患者严重外周缺血之间的关联进行了研究。
在一年时间里，对另外60例SSc患者检测了ACL抗体（IgG和IgM）、抗着丝点抗体和抗Scl - 70抗体。在检测aCL抗体的68例患者中，31例有“严重缺血”，曾发生严重到足以进行截肢（13例）、手术清创或因静脉使用血管扩张剂治疗而住院的指端缺血。
严重缺血患者与无严重缺血患者之间，以及截肢患者与未截肢患者之间，aCL阳性率无差异。31例严重缺血患者中有3例（10%）IgG aCL抗体呈弱至中度滴度，8例（26%）IgM aCL抗体呈弱至中度滴度，而其余患者中分别为10例（27%）和6例（16%）（IgG的p值为0.06，IgM的p值为0.25，Fisher精确检验）。31例严重缺血患者中有17例（55%）抗着丝点抗体阳性，而无缺血的37例患者中有9例（24%）阳性（p = 0.01）。6例严重缺血患者有抗Scl - 70抗体，而无缺血的37例患者中有2例（p = 0.08）。
研究结果不支持aCL抗体与SSc严重缺血之间存在关联，但证实了先前报道的抗着丝点抗体与严重外周缺血之间的关联。虽然抗Scl - 70抗体仅在少数患者中存在，但也有与严重缺血相关的趋势，这表明抗着丝点或抗Scl - 70抗体阳性的患者应被视为有指端丧失的风险。
