抗磷脂综合征的心脏病变

目的分析抗磷脂综合征合并心脏受累的临床特点、治疗和预后,提高对本病的认识。方法对72例抗磷脂综合征患者临床资料进行回顾性分析。结果72例抗磷脂综合征患者中,心脏受累患者48例,二尖瓣受累发病率最高。心脏受累与血栓事件显著相关,与部分激活的凝血活酶时间延长相关。瓣膜病变与脑梗死和器官血栓事件相关。20例有血栓事件并心脏受累的抗磷脂综合征患者接受了抗凝治疗,未再发生血栓事件。结论抗磷脂综合征累及心脏表现为瓣膜异常、冠状动脉血栓、心肌受累和肺动脉高压等,心脏受累可能与高凝状态相关。

Cardiac abnormalities in antiphospholipid syndrome

OBJECTIVE: To investigate the clinical manifestations, treatment and prognosis of antiphospholipid syndrome (APS). METHODS: The cases of 72 patients with defined APS admitted from Jan 1990 to Jan 2006 were analyzed retrospectively. RESULTS: 21 patients with primary APS and 51 patients with secondary APS were studied. Vascular thrombosis was present in 43 (59.7%) of the 72 patients in this study. Cardiac abnormalities could be observed in 48 patients (66.6%). Lesions most frequently involved left-sided valves, mitral (35.4%) more commonly affected than aortic (16.7%). Cardiac involvement was significantly related to thrombosis (P = 0.007) and prolonged activated partial thromboplastin time (APTT) (P = 0.026). Valvular involvement was significantly related to brain infarcts (P = 0.008) and thrombosis (P = 0.029). 20 APS patients with cardiac abnormalities and thrombosis received anticoagulation therapy and thrombosis did not happen any more during follow-up. CONCLUSION: Cardiac manifestations of APS are valve abnormalities (valve thickening and vegetations), occlusive arterial disease (atherosclerosis and myocardial infarction), ventricular dysfunction and pulmonary hypertension. Cardiac abnormalities in APS are likely to be related to hypercoagulability.