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文献速递急性缺血性卒中

抗磷脂抗体在缺血性卒中中的患病率及临床相关性：系统评价与荟萃分析

Prevalence and Clinical Relevance of Antiphospholipid Antibodies in Ischemic Stroke: A Systematic Review and Meta-Analysis
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该系统评价与荟萃分析纳入52项研究，评估抗磷脂抗体（aPL）在缺血性卒中患者中的患病率及其与首发和复发缺血性卒中的关联。结果显示，任何aPL血清阳性的合并患病率为19.1%，且与首发缺血性卒中风险升高相关（OR 2.93），但与复发缺血性卒中风险无显著关联。

要点

  • 缺血性卒中患者中任何aPL血清阳性合并患病率为19.1%。
  • aPL血清阳性与首发缺血性卒中风险升高相关（OR 2.93）。
  • aPL血清阳性与复发缺血性卒中风险无显著关联（OR 1.20）。

核心结论

  • 任何aPL血清阳性见于近五分之一的缺血性卒中患者，并与就诊时缺血性卒中风险升高相关。

研究设计与样本

  • 系统检索PubMed和Embase至2025年5月13日，纳入52项研究（40项病例对照、12项队列）。
  • 采用随机效应模型计算合并患病率和比值比（OR）及95%CI，使用ROBINS-I工具评估偏倚风险。

主要发现

  • 任何aPL血清阳性在缺血性卒中患者中的合并患病率为19.1%（95%CI 15.4%–23.0%；I2=95.8%；51项研究，9438例患者）。
  • 狼疮抗凝物（OR 6.69，95%CI 2.94–15.2；I2=92.6%）和免疫球蛋白G抗心磷脂抗体（OR 2.56，95%CI 1.96–3.35；I2=92.5%）关联最强。
  • aPL血清阳性与复发缺血性卒中风险无显著差异（OR 1.20，95%CI 0.87–1.67；I2=11.4%；9项研究，2873例患者）。

关键数值与推荐

  • aPL血清阳性定义为免疫球蛋白G/免疫球蛋白M抗心磷脂抗体、免疫球蛋白G/免疫球蛋白M抗β2糖蛋白I抗体或狼疮抗凝物中任一阳性。

以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。

原文

Stroke, Volume 57, Issue 10, Page 3024-3034, October 1, 2026. BACKGROUND:Antiphospholipid antibodies (aPL) are associated with an increased risk of thrombosis. However, individual studies have reported conflicting findings regarding the prevalence of aPL in patients with ischemic stroke and their association with first or recurrent events.METHODS:Systematic searches of PubMed and Embase through May 13, 2025 were conducted to identify case-control, cohort, or cross-sectional studies investigating 3 questions related to aPL seropositivity (defined as positivity for either immunoglobulin G/immunoglobulin M anticardiolipin antibody, immunoglobulin G/immunoglobulin M anti-β2 glycoprotein I antibody, or a lupus anticoagulant): (1) the prevalence of aPL seropositivity among individuals with ischemic stroke; (2) the association between aPL seropositivity and the risk of first ischemic stroke; and (3) the association between aPL seropositivity and the risk of recurrent ischemic stroke. Random-effects models with inverse weighting were used to calculate pooled prevalences and odds ratios (OR) with 95% CIs. Risk of bias was assessed using the ROBINS-I tool.RESULTS:A total of 52 studies were included (40 case-control, 12 cohort). The pooled prevalence of seropositivity for any aPL among patients with ischemic stroke (51 studies, 9438 patients) was 19.1% (95% CI, 15.4%–23.0%;I2=95.8%). aPL seropositivity was associated with higher odds of first ischemic stroke (43 studies, 19 097 patients; OR, 2.93 [95% CI, 2.31–3.73];I2=68.7%). The strongest associations were for lupus anticoagulant (OR, 6.69 [95% CI, 2.94–15.2];I2=92.6%) and immunoglobulin G anticardiolipin antibody (OR, 2.56 [95% CI, 1.96–3.35];I2=92.5%). The odds of recurrent ischemic stroke among patients with versus without any aPL seropositivity were not significantly different (OR, 1.20 [95% CI, 0.87–1.67]; 9 studies, 2873 patients,I2=11.4%).CONCLUSIONS:Seropositivity for any aPL was present in nearly 1-in-5 patients with ischemic stroke and was associated with increased odds of ischemic stroke at presentation.

来源：Stroke，查看原文。版权归原作者所有。

引用

  1. Stroke：Prevalence and Clinical Relevance of Antiphospholipid Antibodies in Ischemic Stroke: A Systematic Review and Meta-Analysis
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供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。