血栓性抗磷脂综合征7例回顾性分析

doi:10.3969/j.issn.1004-583X.2021.12.014

摘要/Abstract

摘要：

目的探讨血栓性抗磷脂综合征(antiphospholipid syndrome, APS)的临床表现、实验室检验、神经影像检查、诊治。方法收集 2019年1月至 2020 年11月收治的7例血栓性APS患者的临床资料, 对其临床资料、辅助检查、治疗措施及神经影像等进行回顾性分析。结果 7例抗磷脂抗体均阳性,血栓累及脑、肾、肺1例,考虑灾难性APS,下肢反复动静脉血栓1例,下肢静脉血栓3例,脑梗死3例。病例中合并系统性红斑狼疮2例,合并强直性脊柱炎1例。予以华法林或利伐沙班抗凝等治疗。因合并结核性脑膜炎去世1例,其余6例症状均得到改善。结论血栓性APS的特点是静脉、动脉或微血管血栓形成,是一类异质性很强的疾病。脑循环是最常受影响的动脉领域,血栓性APS的治疗应该评估血栓的风险,分层治疗。

关键词: 抗磷脂综合征, 抗磷脂抗体, 血栓形成, 治疗

Abstract:

Objective To explore the clinical manifestation, laboratory examination, neuroimaging examination, diagnosis and treatment of antiphospholipid syndrome (APS). Methods Collecting the clinical data of 7 patients with thrombotic APS from January 2019 throuh November 2020, retrospectively analyzed their clinical data, auxiliary examinations, treatment measures and neuroimaging. Results Seven cases of antiphospholipid antibodies were all positive, 1 case of thrombosis involved brain, kidney, lung, considering catastrophic APS, 1 case of recurrent arterial and venous thrombosis of lower extremity, 3 cases of lower extremity venous thrombosis, 3 cases of cerebral infarction. Among the cases, there were 2 cases of systemic lupus erythematosus and 1 case of ankylosing spondylitis. The treatment was treated with anticoagulation such as warfarin or rivaroxaban. One patient died of tuberculous meningitis, and the symptoms of the remaining 6 patients improved. Conclusion Thrombotic APS is characterized by venous, arterial or microvascular thrombosis, which is a very heterogeneous disease. Cerebral circulation is the most commonly affected arterial area. The treatment of thrombotic APS should assess the risk of thrombosis and treat it by stratification.

Key words: antiphospholipid syndrome, antiphospholipid antibodies, thrombosis, treatment

中图分类号:

R593.2

尹园园, 任慧玲. 血栓性抗磷脂综合征7例回顾性分析[J]. 临床荟萃, 2021, 36(12): 1123-1127.

Yin Yuanyuan, Ren Huiling. Retrospective analysis of of thrombotic antiphospholipid syndrome: in 7 cases[J]. Clinical Focus, 2021, 36(12): 1123-1127.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.12.014

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I12/1123

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参考文献 18

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编号	性别	年龄(岁)	病程(d)	首诊科室	首发症状	血栓部位	既往史
1	男	26	60	血管外科	右小腿疼痛伴黑硬	下肢动静脉	DVT
2	男	28	7	血管外科	右下肢肿胀疼痛	下肢静脉	无
3	女	30	30	免疫风湿科	左下肢肿胀	下肢静脉	SLE
4	男	53	2	血管外科	左下肢肿胀	下肢静脉	AS
5	男	30	1095	神经内科	右侧肢体无力	颅脑动脉	偏头痛
6	女	52	182	血液科	全血细胞减少	颅脑动脉	SS、脑梗死
7	女	64	180	免疫风湿科	ARDS、全血细胞减少癫痫、肾功能不全	颅脑动脉	SLE、脑梗死

编号	性别	年龄(岁)	病程(d)	首诊科室	首发症状	血栓部位	既往史
1	男	26	60	血管外科	右小腿疼痛伴黑硬	下肢动静脉	DVT
2	男	28	7	血管外科	右下肢肿胀疼痛	下肢静脉	无
3	女	30	30	免疫风湿科	左下肢肿胀	下肢静脉	SLE
4	男	53	2	血管外科	左下肢肿胀	下肢静脉	AS
5	男	30	1095	神经内科	右侧肢体无力	颅脑动脉	偏头痛
6	女	52	182	血液科	全血细胞减少	颅脑动脉	SS、脑梗死
7	女	64	180	免疫风湿科	ARDS、全血细胞减少癫痫、肾功能不全	颅脑动脉	SLE、脑梗死

编号	阳性或滴度升高抗体	最后诊断	治疗	转归
1	aCL, 抗β2GPI, LA	下肢深静脉血栓下肢动脉血栓	华法林3 mg, 1次/d INR2~3	好转
2	aCL, 抗β2GPI, LA	下肢深静脉血栓	华法林4.5 mg,1次/d INR2~3	好转
3	LA	下肢深静脉血栓	利伐沙班20 mg,1次/d	好转
4	LA	下肢深静脉血栓	利伐沙班20 mg, 1次/d	好转
5	aCL, 抗β2GPI, LA	脑梗死	华法林 6 mg, 1次/d INR2~3	好转
6	aCL, 抗β2GPI, LA	脑梗死	阿司匹林100 mg, 1次/d	死亡
7	aCL, 抗β2GPI, LA	脑梗死,肾功能损伤,肺栓塞	激素冲击,华法林 INR2~3	好转

编号	阳性或滴度升高抗体	最后诊断	治疗	转归
1	aCL, 抗β2GPI, LA	下肢深静脉血栓下肢动脉血栓	华法林3 mg, 1次/d INR2~3	好转
2	aCL, 抗β2GPI, LA	下肢深静脉血栓	华法林4.5 mg,1次/d INR2~3	好转
3	LA	下肢深静脉血栓	利伐沙班20 mg,1次/d	好转
4	LA	下肢深静脉血栓	利伐沙班20 mg, 1次/d	好转
5	aCL, 抗β2GPI, LA	脑梗死	华法林 6 mg, 1次/d INR2~3	好转
6	aCL, 抗β2GPI, LA	脑梗死	阿司匹林100 mg, 1次/d	死亡
7	aCL, 抗β2GPI, LA	脑梗死,肾功能损伤,肺栓塞	激素冲击,华法林 INR2~3	好转