Levine S R, Salowich-Palm L, Sawaya K L, Perry M, Spencer H J, Winkler H J, Alam Z, Carey J L
Department of Neurology and Pathology (Immunopathology), Henry Ford Hospital & Health Science Center, Detroit, Mich. 48202-2689, USA.
Stroke. 1997 Sep;28(9):1660-5. doi: 10.1161/01.str.28.9.1660.
Anticardiolipin antibodies (aCL) have been associated with an increased risk of stroke and thrombo-occlusive events. Little is known about the influence of aCL on recurrent thrombo-occlusive events.
Consecutively identified patients (n = 132) with focal cerebral ischemia [stroke = 112, transient ischemic attack (TIA) = 20] harboring aCL of at least 10 GPL units at the time of their index event were prospectively followed to estimate the effect of aCL titer on time to and risk of subsequent thrombo-occlusive events (stroke, TIA, deep venous thrombosis, pulmonary embolism, myocardial infarction) and death. On the basis of prior literature, we divided patients into those with aCL < or = 40 GPL (n = 111; mean age, 63 +/- 14 years; mean follow-up, 1.95 years) and those with aCL > 40 GPL (n = 21; mean age, 54 +/- 20 years; mean follow-up, 1.50 years).
There was no difference between groups for prevalence of hypertension, diabetes mellitus, cigarette smoking, atrial fibrillation, prior TIA, or sex. The GPL > 40 group was younger (54 +/- 20 versus 63 +/- 14 years; P = .055), had more prior strokes [9/21 (48%) versus 27/111 (20%); P = .030], more frequent subsequent thrombo-occlusive events and death [15/21 (71%) versus 51/111 (48%); P = .030], and a shorter median time (years) to event (0.15 versus 0.61, log rank P = .005). The risk ratio for recurrent event and death with GPL > 40 obtained from Cox proportional hazards models, adjusted for prior strokes, prior TIAs, hypertension, diabetes mellitus, atrial fibrillation, and cigarette smoking was 1.9 (95% confidence interval, 1.0 to 3.5; P = .051).
Our data suggest that subsequent thrombo-occlusive events and death after focal cerebral ischemia associated with IgG aCL may occur sooner and more frequently with GPL > 40.
抗心磷脂抗体（aCL）与中风和血栓闭塞性事件风险增加有关。关于aCL对复发性血栓闭塞性事件的影响知之甚少。
前瞻性随访连续确诊的132例局灶性脑缺血患者（中风112例，短暂性脑缺血发作[TIA]20例），这些患者在首次发病时aCL至少为10 GPL单位，以评估aCL滴度对后续血栓闭塞性事件（中风、TIA、深静脉血栓形成、肺栓塞、心肌梗死）发生时间和风险以及死亡的影响。根据既往文献，我们将患者分为aCL≤40 GPL组（n = 111；平均年龄63±14岁；平均随访1.95年）和aCL>40 GPL组（n = 21；平均年龄54±20岁；平均随访1.50年）。
两组在高血压、糖尿病、吸烟、房颤、既往TIA或性别患病率方面无差异。GPL>40组更年轻（54±20岁对63±14岁；P = 0.055），既往中风更多[9/21（48%）对27/111（20%）；P = 0.030]，后续血栓闭塞性事件和死亡更频繁[15/21（71%）对51/111（48%）；P = 0.030]，事件发生的中位时间（年）更短（0.15对0.61，对数秩检验P = 0.005）。根据Cox比例风险模型，在对既往中风、既往TIA、高血压、糖尿病、房颤和吸烟进行校正后，GPL>40时复发性事件和死亡的风险比为1.9（95%置信区间，1.0至3.5；P = 0.051）。
我们的数据表明，与IgG aCL相关的局灶性脑缺血后，GPL>40时后续血栓闭塞性事件和死亡可能更早且更频繁地发生。
