抗磷脂综合征肾损害_West China Medical Journal

Authors：

 张瑞敏 ,  陶冶

四川大学华西医院肾脏内科, 成都 610041;

Corresponding author：

陶冶, Email: yetao11@163.com

Keywords：

抗磷脂综合征; 抗磷脂抗体; 肾脏损害; 抗凝

DOI：

10.7507/1002-0179.20150564

Video：

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Abstract Full text Figures/Tables Video References Cited by

抗磷脂综合征（APS）是一种以动静脉血栓反复形成、病态妊娠及抗磷脂抗体持续阳性为特征的疾病。APS的发病与多种自身抗体相关，如抗心磷脂抗体、抗β-2糖蛋白-1抗体、抗凝血酶原抗体等。临床上根据有无合并其他自身免疫性疾病，分为原发性APS和继发性APS。APS可累及全身各个器官，无论是原发性还是继发性APS，肾脏均是其损害的主要靶器官，肾内各级血管，包括肾动脉主干及其分支，肾小球毛细血管及肾静脉均可出现血栓。APS肾损害的临床表现复杂多样，但缺乏特异性，因此临床诊断比较困难，误诊、漏诊率高，也给治疗带来很大麻烦。APS可导致终末期肾病及移植肾功能不全，一旦诊断明确需要长期抗凝治疗以预防血栓事件，一些新的药物如利妥昔单抗、雷帕霉素等被发现可能对APS有效。

Citation： 张瑞敏, 陶冶. 抗磷脂综合征肾损害. West China Medical Journal, 2015, 30(10): 1975-1978. doi: 10.7507/1002-0179.20150564 Copy

1.	Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)[J]. J Thromb Haemost, 2006, 4(2):295-306.
2.	Sciascia S, Cuadrado MJ, Khamashta M, et al. Renal involvement in antiphospholipid syndrome[J]. Nat Rev Nephrol, 2014, 10(5):279-289.
3.	许菡苡, 赵伟, 胡红, 等. 抗磷脂综合征57例临床分析[J]. 解放军医学院学报, 2014, 35(6):541-544.
4.	Alessandri C, Conti F, Pendolino M, et al. New autoantigens in the antiphospholipid syndrome[J]. Autoimmun Rev, 2011, 10(10):609-616.
5.	Favaloro EJ, Silvestrini R. Assessing the usefulness of anticardiolipin antibody assays:a cautious approach is suggested by high variation and limited consensus in multilaboratory testing[J]. Am J Clin Pathol, 2002, 118(4):548-557.
6.	Farmer-Boatwright MK, Roubey RA. Venous thrombosis in the antiphospholipid syndrome[J]. Arterioscler Thromb Vasc Biol, 2009, 29(3):321-325.
7.	Petri M. Epidemiology of the antiphospholipid antibody syndrome[J]. J Autoimmun, 2000, 15(2):145-151.
8.	Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome:clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients[J]. Arthritis Rheum, 2002, 46(4):1019-1027.
9.	陈芯仪, 孙瑞雪, 吴俣. 抗磷脂综合征临床特征分析[J]. 华西医学, 2014, 29(4):612-615.
10.	Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome:report of an international workshop[J]. Arthritis Rheum, 1999, 42(7):1309-1311.
11.	Sinico RA, Cavazzana I, Nuzzo M, et al. Renal involvement in primary antiphospholipid syndrome:retrospective analysis of 160 patients[J]. Clin J Am Soc Nephrol, 2010, 5(7):1211-1217.
12.	Gigante A, Gasperini ML, Cianci R, et al. Antiphospholipid antibodies and renal involvement[J]. Am J Nephrol, 2009, 30(5):405-412.
13.	Uthman I, Khamashta M. Antiphospholipid syndrome and the kidneys[J]. Semin Arthritis Rheum, 2006, 35(6):360-367.
14.	Alchi B, Griffiths M, Jayne D. What nephrologists need to know about antiphospholipid syndrome[J]. Nephrol Dial Transplant, 2010, 25(10):3147-3154.
15.	周建华, 卢宏柱. 抗磷脂综合征及其肾损害[J]. 临床儿科杂志, 2007, 25(9):725-728.
16.	Chaturvedi S, Brandao L, Geary D, et al. Primary antiphospholipid syndrome presenting as renal vein thrombosis and membranous nephropathy[J]. Pediatr Nephrol, 2011, 26(6):979-985.
17.	Moss KE, Isenberg DA. Comparison of renal disease severity and outcome in patients with primary antiphospholipid syndrome, antiphospholipid syndrome secondary to systemic lupus erythematosus (SLE) and SLE alone[J]. Rheumatology (Oxford), 2001, 40(8):863-867.
18.	Sciascia S, Bertolaccini ML.Thrombotic risk assessment in APS:the global APS score (GAPSS)[J]. Lupus, 2014(23):1286-1287.
19.	Silvariño R, Sant F, Espinosa G, et al. Nephropathy associated with antiphospholipid antibodies in patients with systemic lupus erythematosus[J]. Lupus, 2011, 20(7):721-729.
20.	Tektonidou MG, Sotsiou F, Nakopoulou L, et al. Antiphospholipid syndrome nephropathy in patients with systemic lupus erythematosus and antiphospholipid antibodies:prevalence, clinical associations, and long-term outcome[J]. Arthritis Rheum, 2004, 50(8):2569-2579.
21.	Perez Velsquez CE, Isenberg D, Croca S. Secondary antiphospholipid syndrome nephropathy and lupus nephritis:a case-control study[J]. Ann Rheum Dis, 2013, 72(3):270.
22.	Asherson RA, Khamashta MA, Hughes GR. Hypertension and the antiphospholipid antibodies[J]. Clin Exp Rheumatol, 1993, 11(5):465-467.
23.	Menon RN, Bichile LS. Study of renal histopathological correlation with anticardiolipin antibody status in patients with systemic lupus erythematosus[J]. Indian J Nephrol, 2007, 17:53-60.
24.	Rodríguez-Pintó I, Espinosa G, Cervera R. Catastrophic antiphospholipid syndrome-20 years later[J]. Curr Rheumatol Rev, 2013, 9(2):73-80.
25.	Cervera R. CAPS registry[J]. Lupus, 2012, 21(7):755-757.
26.	Vaidya S. Ten-yr renal allograft survival of patients with antiphospholipid antibody syndrome[J]. Clin Transplant, 2012, 26(6):853-856.
27.	Khamashta MA, Cuadrado MJ, Mujic F, et al. The management of thrombosis in the antiphospholipid-antibody syndrome[J]. N Engl J Med, 1995, 332(15):993-997.
28.	Prakash R, Miller CC, Suki WN. Anticardiolipin antibody in patients on maintenance hemodialysis and its association with recurrent arteriovenous graft thrombosis[J]. Am J Kidney Dis, 1995, 26(2):347-352.
29.	Amigo MC, García-Torres R. Morphology of vascular, renal, and heart lesions in the antiphospholipid syndrome:relationship to pathogenesis[J]. Curr Rheumatol Rep, 2000, 2(3):262-270.
30.	Amigo MC, Garcia-Torres R, Robles M, et al. Renal involvement in primary antiphospholipid syndrome[J]. J Rheumatol, 1992, 19(8):1181-1185.
31.	Scoble T, Wijetilleka S, Khamashta MA. Management of refractory anti-phospholipid syndrome[J]. Autoimmun Rev, 2011, 10(11):669-673.
32.	Sciascia S, Murru V, Sanna G, et al. Clinical accuracy for diagnosis of antiphospholipid syndrome in systemic lupus erythematosus:evaluation of 23 possible combinations of antiphospholipid antibody specificities[J]. J Thromb Haemost, 2012, 10(12):2512-2518.
33.	Mustonen P, Lehtonen KV, Javela K, et al. Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events:a nationwide prospective study[J]. Lupus, 2014, 23(14):1468-1476.
34.	Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome[J].N Engl J Med, 2003, 349(12):1133-1138.
35.	Tektonidou MG. Renal involvement in the antiphospholipid syndrome (APS)-APS nephropathy[J]. Clin Rev Allergy Immunol, 2009, 36(2/3):131-140.
36.	Korkmaz C, Kabukcuoğlu S, Isiksoy S, et al. Renal involvement in primary antiphospholipid syndrome and its response to immunosuppressive therapy[J]. Lupus, 2003, 12(10):760-765.
37.	Arachchillage DJ, Cohen H. Use of new oral anticoagulants in antiphospholipid syndrome[J]. Curr Rheumatol Rep, 2013, 15(6):331.
38.	Ramos-Casals M, Brito-Zerón P, Muñoz S, et al. A systematic review of the off-label use of biological therapies in systemic autoimmune diseases[J]. Medicine (Baltimore), 2008, 87(6):345-364.
39.	Velik-Salchner C, Lederer W, Wiedermann FJ. Eculizumab and renal transplantation in a patient with catastrophic antiphospholipid syndrome:effect of heparin on complement activation[J]. Lupus, 2011, 20(7):772.
40.	Canaud G, Bienaimé F, Tabarin F, et al. Inhibition of the mTORC pathway in the antiphospholipid syndrome[J]. N Engl J Med, 2014, 371(4):303-312.

1. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)[J]. J Thromb Haemost, 2006, 4(2):295-306.
2. Sciascia S, Cuadrado MJ, Khamashta M, et al. Renal involvement in antiphospholipid syndrome[J]. Nat Rev Nephrol, 2014, 10(5):279-289.
3. 许菡苡, 赵伟, 胡红, 等. 抗磷脂综合征57例临床分析[J]. 解放军医学院学报, 2014, 35(6):541-544.
4. Alessandri C, Conti F, Pendolino M, et al. New autoantigens in the antiphospholipid syndrome[J]. Autoimmun Rev, 2011, 10(10):609-616.
5. Favaloro EJ, Silvestrini R. Assessing the usefulness of anticardiolipin antibody assays:a cautious approach is suggested by high variation and limited consensus in multilaboratory testing[J]. Am J Clin Pathol, 2002, 118(4):548-557.
6. Farmer-Boatwright MK, Roubey RA. Venous thrombosis in the antiphospholipid syndrome[J]. Arterioscler Thromb Vasc Biol, 2009, 29(3):321-325.
7. Petri M. Epidemiology of the antiphospholipid antibody syndrome[J]. J Autoimmun, 2000, 15(2):145-151.
8. Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome:clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients[J]. Arthritis Rheum, 2002, 46(4):1019-1027.
9. 陈芯仪, 孙瑞雪, 吴俣. 抗磷脂综合征临床特征分析[J]. 华西医学, 2014, 29(4):612-615.
10. Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome:report of an international workshop[J]. Arthritis Rheum, 1999, 42(7):1309-1311.
11. Sinico RA, Cavazzana I, Nuzzo M, et al. Renal involvement in primary antiphospholipid syndrome:retrospective analysis of 160 patients[J]. Clin J Am Soc Nephrol, 2010, 5(7):1211-1217.
12. Gigante A, Gasperini ML, Cianci R, et al. Antiphospholipid antibodies and renal involvement[J]. Am J Nephrol, 2009, 30(5):405-412.
13. Uthman I, Khamashta M. Antiphospholipid syndrome and the kidneys[J]. Semin Arthritis Rheum, 2006, 35(6):360-367.
14. Alchi B, Griffiths M, Jayne D. What nephrologists need to know about antiphospholipid syndrome[J]. Nephrol Dial Transplant, 2010, 25(10):3147-3154.
15. 周建华, 卢宏柱. 抗磷脂综合征及其肾损害[J]. 临床儿科杂志, 2007, 25(9):725-728.
16. Chaturvedi S, Brandao L, Geary D, et al. Primary antiphospholipid syndrome presenting as renal vein thrombosis and membranous nephropathy[J]. Pediatr Nephrol, 2011, 26(6):979-985.
17. Moss KE, Isenberg DA. Comparison of renal disease severity and outcome in patients with primary antiphospholipid syndrome, antiphospholipid syndrome secondary to systemic lupus erythematosus (SLE) and SLE alone[J]. Rheumatology (Oxford), 2001, 40(8):863-867.
18. Sciascia S, Bertolaccini ML.Thrombotic risk assessment in APS:the global APS score (GAPSS)[J]. Lupus, 2014(23):1286-1287.
19. Silvariño R, Sant F, Espinosa G, et al. Nephropathy associated with antiphospholipid antibodies in patients with systemic lupus erythematosus[J]. Lupus, 2011, 20(7):721-729.
20. Tektonidou MG, Sotsiou F, Nakopoulou L, et al. Antiphospholipid syndrome nephropathy in patients with systemic lupus erythematosus and antiphospholipid antibodies:prevalence, clinical associations, and long-term outcome[J]. Arthritis Rheum, 2004, 50(8):2569-2579.
21. Perez Velsquez CE, Isenberg D, Croca S. Secondary antiphospholipid syndrome nephropathy and lupus nephritis:a case-control study[J]. Ann Rheum Dis, 2013, 72(3):270.
22. Asherson RA, Khamashta MA, Hughes GR. Hypertension and the antiphospholipid antibodies[J]. Clin Exp Rheumatol, 1993, 11(5):465-467.
23. Menon RN, Bichile LS. Study of renal histopathological correlation with anticardiolipin antibody status in patients with systemic lupus erythematosus[J]. Indian J Nephrol, 2007, 17:53-60.
24. Rodríguez-Pintó I, Espinosa G, Cervera R. Catastrophic antiphospholipid syndrome-20 years later[J]. Curr Rheumatol Rev, 2013, 9(2):73-80.
25. Cervera R. CAPS registry[J]. Lupus, 2012, 21(7):755-757.
26. Vaidya S. Ten-yr renal allograft survival of patients with antiphospholipid antibody syndrome[J]. Clin Transplant, 2012, 26(6):853-856.
27. Khamashta MA, Cuadrado MJ, Mujic F, et al. The management of thrombosis in the antiphospholipid-antibody syndrome[J]. N Engl J Med, 1995, 332(15):993-997.
28. Prakash R, Miller CC, Suki WN. Anticardiolipin antibody in patients on maintenance hemodialysis and its association with recurrent arteriovenous graft thrombosis[J]. Am J Kidney Dis, 1995, 26(2):347-352.
29. Amigo MC, García-Torres R. Morphology of vascular, renal, and heart lesions in the antiphospholipid syndrome:relationship to pathogenesis[J]. Curr Rheumatol Rep, 2000, 2(3):262-270.
30. Amigo MC, Garcia-Torres R, Robles M, et al. Renal involvement in primary antiphospholipid syndrome[J]. J Rheumatol, 1992, 19(8):1181-1185.
31. Scoble T, Wijetilleka S, Khamashta MA. Management of refractory anti-phospholipid syndrome[J]. Autoimmun Rev, 2011, 10(11):669-673.
32. Sciascia S, Murru V, Sanna G, et al. Clinical accuracy for diagnosis of antiphospholipid syndrome in systemic lupus erythematosus:evaluation of 23 possible combinations of antiphospholipid antibody specificities[J]. J Thromb Haemost, 2012, 10(12):2512-2518.
33. Mustonen P, Lehtonen KV, Javela K, et al. Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events:a nationwide prospective study[J]. Lupus, 2014, 23(14):1468-1476.
34. Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome[J].N Engl J Med, 2003, 349(12):1133-1138.
35. Tektonidou MG. Renal involvement in the antiphospholipid syndrome (APS)-APS nephropathy[J]. Clin Rev Allergy Immunol, 2009, 36(2/3):131-140.
36. Korkmaz C, Kabukcuoğlu S, Isiksoy S, et al. Renal involvement in primary antiphospholipid syndrome and its response to immunosuppressive therapy[J]. Lupus, 2003, 12(10):760-765.
37. Arachchillage DJ, Cohen H. Use of new oral anticoagulants in antiphospholipid syndrome[J]. Curr Rheumatol Rep, 2013, 15(6):331.
38. Ramos-Casals M, Brito-Zerón P, Muñoz S, et al. A systematic review of the off-label use of biological therapies in systemic autoimmune diseases[J]. Medicine (Baltimore), 2008, 87(6):345-364.
39. Velik-Salchner C, Lederer W, Wiedermann FJ. Eculizumab and renal transplantation in a patient with catastrophic antiphospholipid syndrome:effect of heparin on complement activation[J]. Lupus, 2011, 20(7):772.
40. Canaud G, Bienaimé F, Tabarin F, et al. Inhibition of the mTORC pathway in the antiphospholipid syndrome[J]. N Engl J Med, 2014, 371(4):303-312.

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