Taylor L M, Chitwood R W, Dalman R L, Sexton G, Goodnight S H, Porter J M
Division of Vascular Surgery, Oregon Health Sciences University, Portland.
Ann Surg. 1994 Oct;220(4):544-50; discussion 550-1. doi: 10.1097/00000658-199410000-00012.
Autoantibodies to phospholipid (aPL) have been associated with vascular thromboses in cerebral, coronary, and peripheral venous and arterial sites. To date, no large cross-sectional study has examined the incidence of occurrence of aPL in patients with peripheral arterial disease.
A cross-sectional study was performed with patients admitted for vascular surgery procedures to treat peripheral arterial disease for 23 months between January 1, 1990 and November 1, 1991. Consecutive patients were evaluated for the presence of aPL. Medical records for each patient were reviewed in detail, and historic, operative, and postoperative parameters were tabulated for relationship to the presence of aPL.
Two hundred thirty-four patients underwent complete testing for aPL. All patients were receiving chronic aspirin therapy. This represented 86% of admissions. Antiphospholipid antibodies were detected in 60 patients (26%). No differences in age, sex, operation performed, or postoperative outcome were found between patients with and without aPL. However, patients with aPL were 1.8 times more likely to have undergone previous lower extremity (LE) vascular surgery than patients without aPL (95% confidence interval = 1.0 - 3.6, p = 0.047). Patients with aPL and previous LE vascular surgery were 5.6 times more likely to have had occlusion of that procedure than patients without aPL (95% confidence interval = 1.9 - 16.8, p = 0.03). The occluded previous LE procedures had a shorter duration of patency before occlusion in patients with aPL than in those without (mean duration of patency 17 months vs. 50 months, p < 0.003). Patients with occluded previous LE procedures and aPL were 4 times more likely to be female (95% C.I. = 1.4 - 11.3, p = 0.018).
The incidence of aPL in vascular surgery patients is substantial. Vascular surgery patients with aPL are more likely to have failure of previous LE bypass procedures and to be female and the bypass failure occurs significantly more rapidly than in patients without aPL. Based on these data, testing of vascular surgery patients for aPL and investigation of alternative antithrombotic treatment regimens in patients with aPL appears warranted.
抗磷脂自身抗体（aPL）与脑、冠状动脉及外周动静脉部位的血管血栓形成有关。迄今为止，尚无大型横断面研究探讨外周动脉疾病患者中aPL的发生率。
1990年1月1日至1991年11月1日期间，对因血管外科手术治疗外周动脉疾病而入院的患者进行了为期23个月的横断面研究。对连续的患者进行aPL检测。详细查阅每位患者的病历，并将病史、手术及术后参数制成表格，以分析与aPL存在情况的关系。
234例患者接受了aPL的全面检测。所有患者均接受慢性阿司匹林治疗。这占入院患者的86%。60例患者（26%）检测到抗磷脂抗体。有aPL和无aPL的患者在年龄、性别、所行手术或术后结果方面均未发现差异。然而，有aPL的患者既往接受下肢（LE）血管手术的可能性是无aPL患者的1.8倍（95%置信区间=1.0 - 3.6，p = 0.047）。有aPL且既往接受过LE血管手术的患者，该手术发生闭塞的可能性是无aPL患者的5.6倍（95%置信区间=1.9 - 16.8，p = 0.03）。与无aPL的患者相比，有aPL的患者既往闭塞的LE手术在闭塞前的通畅时间更短（平均通畅时间17个月对50个月，p < 0.003）。既往LE手术闭塞且有aPL的患者为女性的可能性是无aPL患者的4倍（95%置信区间=1.4 - 11.3，p = 0.018）。
血管外科手术患者中aPL的发生率较高。有aPL的血管外科手术患者既往LE搭桥手术失败的可能性更大，且女性居多，且搭桥失败的发生明显比无aPL的患者更快。基于这些数据，对血管外科手术患者进行aPL检测以及对有aPL的患者研究替代抗血栓治疗方案似乎是必要的。
