CAJ | 학술논문

目的：研究抗心磷脂抗体阳性而不能诊断为抗磷脂综合征( APS)患者的病因构成和临床特点。方法回顾性分析华西医院2009年01月至2014年01月抗心磷脂抗体( anti-cardiolipin antibody,aCL)阳性且不能诊断为APS的病例共694例。根据第13届抗磷脂抗体国际会议建议将aCL值分为低滴度和中高滴度进行病因统计,并分析aCL滴度对系统性红斑狼疮( SLE)临床特点的影响。结果① aCL阳性可见于多种疾病。最多见于自身免疫性疾病,其次为缺血性脑血管疾病、感染性疾病、恶性肿瘤、肾脏疾病,还可以见于其他神经系统疾病、淋巴增殖性疾病、发热原因未明等其他疾病。② aCL阳性在自身免疫性疾病中以SLE最多,其次为重叠综合征、类风湿关节炎,还可见于干燥综合征、炎性肌病、未分化结缔组织病、硬皮病等。③在SLE患者中,中高滴度aCL组血小板减少及Coombs试验阳性的贫血的发生率均明显高于低滴度组,差异有统计学意义(P<0.01)。④中高滴度aCL组抗dsDNA抗体阳性、aPTT延长、血栓事件、狼疮肾炎、狼疮脑病、心脏瓣膜病变等临床特点的发生率均高于低滴度组,但差异无统计学意义(P>0.05)。结论aCL临床意义需结合临床表现综合判断。
목적：연구항심린지항체양성이불능진단위항린지종합정( APS)환자적병인구성화림상특점。방법회고성분석화서의원2009년01월지2014년01월항심린지항체( anti-cardiolipin antibody,aCL)양성차불능진단위APS적병례공694례。근거제13계항린지항체국제회의건의장aCL치분위저적도화중고적도진행병인통계,병분석aCL적도대계통성홍반랑창( SLE)림상특점적영향。결과① aCL양성가견우다충질병。최다견우자신면역성질병,기차위결혈성뇌혈관질병、감염성질병、악성종류、신장질병,환가이견우기타신경계통질병、림파증식성질병、발열원인미명등기타질병。② aCL양성재자신면역성질병중이SLE최다,기차위중첩종합정、류풍습관절염,환가견우간조종합정、염성기병、미분화결체조직병、경피병등。③재SLE환자중,중고적도aCL조혈소판감소급Coombs시험양성적빈혈적발생솔균명현고우저적도조,차이유통계학의의(P<0.01)。④중고적도aCL조항dsDNA항체양성、aPTT연장、혈전사건、랑창신염、랑창뇌병、심장판막병변등림상특점적발생솔균고우저적도조,단차이무통계학의의(P>0.05)。결론aCL림상의의수결합림상표현종합판단。
Objective To determine the etiologic composition and clinical characteristics of anticardio-lipin antibodies( aCL)-positive patients. Methods 694 aCL positive patients that did not fulfill the diagnostic criteria of anti-phospholipid syndrome( APS) were retrospectively investigated and analyzed from January 2009 to January 2014 in West China Hospital. The diagnosis and etiology were collected according to the aCLsemi-quantitative categories(low-,medium/moderate-,and high positive)from the 13 th International Congress on Antiphospholipid Antibodies. The association of clinical feature in systemic lupus erthythematosus with differ-ent aCL titers was analyzed. Results ①The most common etiology of aCL positive are autoimmune diseases, followed by ischemic cerebrovascular diseases, infectious diseases, malignancies, renal diseases and fever of unknown origin etc.② In autoimmune diseases,aCL positive is most prominent in SLE patients,and the rests are overlap syndrome,rheumatoid arthritis(RA),Sjogren syndrome(SS),undifferentiated connective tissue diseases( UCTD ) and scleroderma etc. ③ In SLE patients, the incidence of thrombocytopenia and anemia ( Coombs test positive) is much higher in moderate/high aCL titers group than that in low titers group. It has statistic difference(P <0. 01). ④ In SLE patients,the incidence of anti-dsDNA antibody,prolongation of aPTT, thrombotic events, lupus nephritis, lupus encephalopathy and cardiac valves involvement is higher in moderate/high aCL titers group than that in low titers group. It does not have statistic difference(P>0. 05). Conclusion The clinical significances of aCL are diverse and complex and could be interpreted based on the clinical manifestations.