Brey R L, Escalante A
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7883, USA.
Lupus. 1998;7 Suppl 2:S67-74. doi: 10.1177/096120339800700216.
Thrombosis, thrombocytopenia, recurrent fetal loss and a variety of non-thrombotic neurological disorders have all been associated with antiphospholipid antibodies (aPL). Cerebral ischemia associated with aPL is the most common arterial thrombotic manifestation. Depression, cognitive dysfunction, depression and psychosis have all been associated with aPL. The presumed pathophysiologic mechanism underlying these manifestations is thought to be a result of cerebral ischemia in some, but not all cases. Seizures, chorea and transverse myelitis all appear to be associated with aPL. An interaction between aPL and central nervous system cellular elements rather than aPL-associated thrombosis seems to be a more plausible mechanism for these clinical manifestations. Migraine on the other hand, does not appear to be associated with aPL in either lupus or non-lupus populations. Neuroimaging studies show an increased frequency of brain abnormalities in patients with aPL, but none appear to be specific. The best treatment strategy for preventing neurological manifestations of aPL is not fully defined. For thrombotic manifestations, both antiplatelet and anticoagulant therapies have been suggested. In some patients, immunosuppressant therapy has been used. For non-thrombotic manifestations, some combination of immunosuppressant therapy and symptomatic treatment may be warranted.
血栓形成、血小板减少、复发性流产以及多种非血栓性神经疾病均与抗磷脂抗体（aPL）有关。与aPL相关的脑缺血是最常见的动脉血栓形成表现。抑郁、认知功能障碍、抑郁和精神病均与aPL有关。这些表现背后推测的病理生理机制在某些但并非所有情况下被认为是脑缺血的结果。癫痫、舞蹈症和横贯性脊髓炎似乎都与aPL有关。aPL与中枢神经系统细胞成分之间的相互作用而非aPL相关的血栓形成似乎是这些临床表现更合理的机制。另一方面，偏头痛在狼疮患者和非狼疮患者人群中似乎均与aPL无关。神经影像学研究显示aPL患者脑部异常的频率增加，但似乎均无特异性。预防aPL神经表现的最佳治疗策略尚未完全明确。对于血栓形成表现，已建议使用抗血小板和抗凝治疗。在一些患者中，已使用免疫抑制治疗。对于非血栓形成表现，可能需要免疫抑制治疗和对症治疗的某种组合。
