抗フォスフォリピド抗体と,後に発生した血栓閉塞事件は,不全性脳卒中の患者において発生した
Steven R Levine1, Robin L Brey, Barbara C Tilley
1Department of Neurology, Mt Sinai School of Medicine, New York, NY 10029-6574, USA. steven.levine@mssm.edu
JAMA
|February 6, 2004
まとめ
アンチフォスフォリピド抗体 (aPL) は,不全性脳卒中患者の再発性血管イベントを予測することはできません. アスピリンやワルファリンに対する治療反応を変更しないため,aPLのスクリーニングは推奨されません.
科学分野:
- 神経学 神経学とは
- 免疫学 免疫学とは
- 心血管医学 心血管医学
背景:
- アンチフォスフォリピド抗体 (aPL) は,血管閉塞イベントに関連しています.
- 缺血性イベント,特に再発性脳卒中におけるaPLの予測的役割は,依然として議論されている.
研究 の 目的:
- ベースラインaPL陽性度が将来の血栓閉塞イベントを予測するかどうかを評価する.
- aPL状態が脳卒中患者のワーファリンに対する治療反応とアスピリンの治療反応に影響するかどうかを判断する.
主な方法:
- 1770人の不全性脳卒中患者を対象としたランダム化試験 (WARSS) のプロスペクティブコホート研究 (APASS).
- ベースラインaPL状態 (アンチカルジオリピン抗体[aCL],狼抗凝固抗体[LA]) は,インデックス・ストロックの90日以内に分析された.
- 死亡,不全性脳卒中,その他の血栓閉塞性イベントを含む複合エンドポイントの2年間の追跡調査.
主要な成果:
- ワルファリン (RR 0.99) やアスピリン (RR 0.94) を服用していたaPL陽性患者では,血栓閉塞イベントのリスクの増加は認められなかった.
- 全体的なイベント率は,aPL陽性 (22.2%) とaPL陰性 (21.8%) の患者の間で類似していました.
- aPL状態との有意な治療相互作用は観察されなかった.
結論:
- ベースラインのaPL陽性度は,不全性脳卒中患者の後の血管疾患を予測するものではありません.
- aPLステータスは,アスピリンまたはワルファリン療法に対する差異的な反応を示さない.
- 発血性脳卒中患者のaPLの定期的なスクリーニングは,臨床的に正当化されていません.
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