抗心磷脂抗体阳性脑梗塞二级防治探究.doc

抗心磷脂抗体阳性脑梗塞二级防治探究 　 作者：林仲辉，陈进春，王芸素，王进，吴仕福，龙喜带 【摘要】 目的 探讨小剂量、短疗程、个体化的免疫抑制及抗凝疗法在抗心磷脂抗体(anticardiolipin antibody, ACL)阳性脑梗塞二级防治中的有效性和安全性。方法 采用标准对照研究方法随访观察标准组(即单纯阿司匹林治疗组，共27例)、对照1组(即阿司匹林联合激素治疗组，共31例)及对照2组(即阿司匹林联合激素及肝素钠治疗组，共34例)三组脑梗塞的再发事件，分析小剂量、短疗程、个体化的免疫抑制及抗凝疗法在ACL阳性脑梗塞二级防治中的有效性及安全性。结果 在治疗后3年随防观察期内，标准组再发缺血性脑卒中(包括短暂性脑缺血发作和再发脑梗塞)再发事件发生率为37.04%(10/27)，明显高于对照1组[6.45%(2/31)]和对照2组[2.94%(1/34)]，Plt;0.01。三组均未见脑出血再发。结论 小剂量、短疗程、个体化的免疫抑制和抗凝疗法对ACL阳性脑梗塞患者再发事件中的二级防治有效且安全。 【关键词】 抗体，抗心脂;脑梗塞;再发事件;二级防治 　　Abstract: Objective To outline the efficacy and safety of the secondary prevention and therapy with low-dose, short-course and individualized immunosuppressors and anticoagulants for cerebral infarction (CI) patients with positive-anticardiolipin antibody (ACL). Methods This study, including criterion group (namely group accepting therapeusis with aspirin, n=27), control 1 (namely group accepting therapeusis with aspirin plus prednisone, n=31), and control 2 (namely group accepting therapeusis with aspirin plus prednisone and heparin, n=34), was carried out by means of analyzing recurrent events such as transient ischemic attack (TIA), recurrent CI (RCI), recurrent cerebral ischemic apoplexy (RCIA), and cerebral hemorrhage (CH) during the follow-up observation after treatment for cerebral infarction cases with positive-ACL. Results During 3-year follow-up after treatment of all participants, the incidence of RCIA consisting of TIA and RCI in criterion group was 37.04% (10/27), which was significantly higher than that in control 1 with 6.45% (2/31) and control 2 with 2.94% (1/34), Plt;0.01, while no patients of all three groups suffered with CH. Conclusion These results suggest that it is effective and safe for the secondary prevention and therapy with low-dose, short-course and individualized immunosuppressors and anticoagulants for patients with CI associated with positive-ACL. 　　Key words: antibodies, anticardiolipin; brain infarction; recurrent event; the second preventi