Bick R L, Baker W F
Presbyterian Comprehensive Cancer Center, Presbyterian Hospital of Dallas, Texas.
Med Clin North Am. 1994 May;78(3):667-84. doi: 10.1016/s0025-7125(16)30152-3.
Anticardiolipin antibodies and the lupus anticoagulant are strongly associated with thrombosis and appear to be the most common of the acquired blood protein defects causing thrombosis. Although the precise mechanism(s) whereby antiphospholipid antibodies alter hemostasis to induce a hypercoagulable state remain unclear, several theories have been advanced. The commonest thrombotic events associated with anticardiolipin antibodies are deep vein thrombosis and pulmonary embolus (type I syndrome), coronary or peripheral artery thrombosis (type II syndrome), or cerebrovascular/retinal vessel thrombosis (type III syndrome), and occasionally patients present with mixtures (type IV syndrome). The relative frequency of anticardiolipin antibodies in association with arterial and venous thrombosis strongly suggests that these should be looked for in any individual with unexplained thrombosis; all three idiotypes (IgG, IgA, and IgM) should be assessed. Also, the type of syndrome (I through IV) should be defined if possible because this may dictate both type and duration of immediate and long-term anticoagulant therapy. In contrast to those with anticardiolipin antibodies, patients with primary lupus anticoagulant thrombosis syndrome usually suffer venous thrombosis. Because the aPTT is unreliable in patients with lupus anticoagulant (prolonged in only about 40% to 50% of patients) and is not usually prolonged in patients with anticardiolipin antibodies, definitive tests (ELISA for anticardiolipin antibody and the dRVVT for lupus anticoagulant) should be immediately ordered when suspecting antiphospholipid syndrome or in individuals with otherwise unexplained thrombotic or thromboembolic events.
抗心磷脂抗体和狼疮抗凝物与血栓形成密切相关，似乎是导致血栓形成的后天性血液蛋白缺陷中最常见的。尽管抗磷脂抗体改变止血机制以诱导高凝状态的确切机制尚不清楚，但已经提出了几种理论。与抗心磷脂抗体相关的最常见血栓事件是深静脉血栓形成和肺栓塞（I型综合征）、冠状动脉或外周动脉血栓形成（II型综合征）或脑血管/视网膜血管血栓形成（III型综合征），偶尔患者会出现混合情况（IV型综合征）。抗心磷脂抗体与动脉和静脉血栓形成相关的相对频率强烈表明，任何原因不明的血栓形成个体都应进行检测；应评估所有三种独特型（IgG、IgA和IgM）。此外，如果可能，应确定综合征类型（I至IV型），因为这可能决定即时和长期抗凝治疗的类型和持续时间。与抗心磷脂抗体患者不同，原发性狼疮抗凝物血栓形成综合征患者通常发生静脉血栓形成。由于狼疮抗凝物患者的活化部分凝血活酶时间（aPTT）不可靠（仅约40%至50%的患者延长），且抗心磷脂抗体患者通常不延长，因此当怀疑抗磷脂综合征或有其他原因不明的血栓形成或血栓栓塞事件的个体时，应立即进行确诊检查（抗心磷脂抗体酶联免疫吸附测定和狼疮抗凝物的稀释蝰蛇毒时间测定）。
