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中华眼科医学杂志(电子版) ›› 2022, Vol. 12 ›› Issue (06) : 367 -371. doi: 10.3877/cma.j.issn.2095-2007.2022.06.009

综述

抗磷脂抗体相关视网膜血管阻塞的研究进展
陈子扬1, 谢立科2,(), 郝晓凤2, 张小艳2   
  1. 1. 100007 北京,中国中医科学院眼科医院2021级博士研究生
    2. 100040 北京,中国中医科学院眼科医院内障眼病科
  • 收稿日期:2021-10-29 出版日期:2022-12-28
  • 通信作者: 谢立科
  • 基金资助:
    北京市自然科学基金项目(7192235); 中国中医科院科技创新工程重大攻关项目(CI2021A02606)

Progress in the retinal vascular obstruction associated with anti-phospholipid antibodies

Ziyang Chen1, Like Xie2,(), Xiaofeng Hao2, Xiaoyan Zhang2   

  1. 1. Doctoral degree 2021, Chinese Academy of Traditional Chinese Medicine, Beijing 100007, China
    2. Department of Endopathic Ophthalmology, Eye Hospital of China Academy of Chinese Medical Sciences, Beijing 100040, China
  • Received:2021-10-29 Published:2022-12-28
  • Corresponding author: Like Xie
引用本文:

陈子扬, 谢立科, 郝晓凤, 张小艳. 抗磷脂抗体相关视网膜血管阻塞的研究进展[J/OL]. 中华眼科医学杂志(电子版), 2022, 12(06): 367-371.

Ziyang Chen, Like Xie, Xiaofeng Hao, Xiaoyan Zhang. Progress in the retinal vascular obstruction associated with anti-phospholipid antibodies[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(06): 367-371.

近年来,抗磷脂抗体(aPL)相关视网膜血管阻塞受到越来越多的关注,尤其在发病年龄小、无高血压及无糖尿病等高危因素群体中更明显。当该类人群发生视网膜血管阻塞时,应重点排除与aPL的相关性。aPL相关视网膜血管阻塞的发病机制主要与aPL导致的血栓形成有关,包括前列环素合成减少、诱导血小板聚集、蛋白C活化抑制、纤维蛋白溶解减少及中性粒细胞活化激活等。aPL相关的视网膜血管阻塞具有发病年龄无特定性、症状体征无独特性及实验室检查结果具有多样性等临床特点。当前,aPL相关视网膜血管阻塞的治疗主要以抗血栓形成和治疗预防眼部新生血管等并发症为主,前者包括了抗血小板药物、抗凝药物、静脉注射免疫球蛋白、血浆交换、溶栓及重组组织纤溶酶原激活剂等;后者包括视网膜激光凝固术、玻璃体腔注射抗血管内皮生长因子及注射用地塞米松植入剂等。但原发病的治疗方案对眼局部病情的控制效果不一,尚需更多的循证医学依据以进一步规范化治疗方案。

In recent years, anti-phospholipid antibody-related retinal vascular obstruction (RVO) has been gradually concerned, especially in the onset of young and small groups with no high-risk factors such as hypertension and diabetes, etc. RVO associated with anti-phospholipid antibody should be excluded once they were diagnosed as RVO. The pathogenesis of anti-phospholipid antibody-associated RVO is mainly associated with thrombosis caused by anti-phospholipid antibodies, which including reducing prostacyclin synthesis, platelet aggregation, the inhibition of protein C activation, reducing fibrinolysis, and promoting neutrophil activation, etc. The RVO associated with anti-phospholipid antibodies has many clinical characteristics, such as no specific age of onset, no uniqueness of symptoms and signs, and a diversity of laboratory findings. The current treatment mainly focuses on antithrombosis and treatment and prevention of ocular neovascular complications. The former includes antiplatelet drugs, anticoagulant drugs, human intravenous immunoglobulin, plasma exchange, thrombolytic therapy, and application of recombinant tissue plasminogen activator; and the latter includes retinal laser coagulation, intravitreal injection of anti-vascular endothelial growth factor or dexamethasone implant for injection. However, the treatment plan of the original disease is divided on the control effect of the local eye condition, and more evidence-based basis is needed to further standardize the treatment plan of the disease.

表1 抗磷脂抗体相关视网膜血管阻塞特殊病例的特点汇总
第一作者 年份(年) 病例简述 特点
Lu等[47] 2022 患者女性,12岁。CRVO,实验室检查仅见anti-β2GPⅠ为31.46 RU/mL稍高。予阿司匹林肠溶片口服,150 mg/d,玻璃体内注射地塞米松玻璃体内植入剂,术后恢复正常,随访1年未复发。 玻璃体内注射地塞米松玻璃体内植入剂疗效佳。
Joäo等[49] 2022 患者男性,11岁。CRVO伴ME,实验室检查aCL、anti-β2GPⅠ及LA IgG均升高。给予低分子肝素和全身类固醇激素,3 d后病情加重,视力下降为光感,予华法林维持治疗12个月,BCVA恢复至数指,视网膜内层和视神经萎缩。 给予抗凝剂和激素后病情仍可能继续加重,改用华法林治疗。
Moreno-Páramo等[32] 2019 患者男性,14岁。CRVO和CRAO,实验室检查aCL、anti-β2GPⅠ及LA均为阳性。给予激素和口服抗凝药7 d后,由于凝血时间延长,出现玻璃体积血,给予玻璃体切割术联合视网膜激光凝固术联合玻璃体腔注射雷珠单抗注射液,随访1年未见新生血管以及血栓再发生。 抗凝药使用应注意检测凝血时间,由于凝血时间延长导致的玻璃体出血有继发新生血管性青光眼的风险。
Korematsu等[16] 2014 患者女性,15岁。CRVO,实验室检查aCL、anti-β2GPⅠ及LA IgG均为阴性,而抗磷脂酰胆碱、抗磷脂酰乙醇胺、抗磷脂酰肌醇IgG抗体及磷脂酰丝氨酸IgG抗体水平升高。给予低分子肝素、类固醇激素、华法林、阿司匹林、泼尼松龙及他克莫司等治疗,病情好转。 APS实验室诊断标志物可能为非标准标志物异常,如抗磷脂酸、磷脂酰乙醇胺、磷脂酰肌醇、磷脂酰胆碱及磷脂酰甘油等。
Modrzejewska等[9] 2013 患者女性,1个月。CRVO,实验室检查aCL IgG升高,aCL IgM和aβ2GPⅠ正常。其母亲确诊为APS,给予局部滴眼液治疗,视力提高。 发病年龄最小,具有家族史。
[1]
Limper M, de Leeuw K, Lely AT, et al. Diagnosing and treating antiphospholipid syndrome: a consensus paper[J]. Neth J Med, 2019, 77(3): 98-108.
[2]
Coniglio M, Platania A, Di-Nucci GD, et al. Antiphospholipid-protein antibodies are not an uncommon feature in retinal venous occlusions[J]. Thromb Res, 1996, 83(2): 183-188 .
[3]
戴艳丽,魏世辉,黄厚斌. 抗磷脂抗体与视网膜静脉阻塞相关性的荟萃分析[J]. 中华眼底病杂志201329(2):188-192.
[4]
Houghton DE, Moll S. Antiphospholipid antibodies[J]. Vasc Med, 2017, 22(6): 545-550.
[5]
徐敏倩,罗晓红. 抗磷脂抗体综合征相关性复发性流产的研究进展[J].中国医药科学2021, 11(10):45-48,64.
[6]
Yehudai D, Shoenfeld Y, Toubi E. Looking into the eyes of patients with antiphospholipid syndrome[J]. Clin Rev Allergy Immunol, 2007, 32(2): 192-197.
[7]
徐秋霞,王松,赵永志,等 .血栓栓塞性疾病[M]. 北京:中国医药科技出版社,2004:506-507.
[8]
林松波,陈韵蕉,郑悦,等 .血栓·抗凝·溶栓[M]. 福州:福建科学技术出版社出版,1999:103-104.
[9]
Modrzejewska M, Michalak A, Szmigiel O, et al. Ocular manifestations in a newborn from a pregnancy complicated by an antiphospholipid syndrome——a case report[J]. Ginekol Pol, 2013, 84(10): 888-891.
[10]
Storey P, Ter-Zakarian A, Rao N, et al. Severe bilateral retinal vascular occlusion as first presentation of systemic lupus erythematosus and antiphospholipid syndrome[J]. Retin Cases Brief Rep, 2017, 11(S1): S44-S48.
[11]
Ang LP, Lim AT, Yap EY. Central retinal vein and ophthalmic artery occlusion in primary antiphospholipid syndrome[J]. Eye (Lond), 2004, 18(4): 439-440.
[12]
Castañón C, Amigo MC, Bañales JL, et al. Ocular vaso-occlusive disease in primary antiphospholipid syndrome[J]. Ophthalmology, 1995, 102(2): 256-262.
[13]
Kleiner RC, Najarian LV, Schatten S, et al. Vaso-occlusive retinopathy associated with antiphospholipid antibodies (lupus anticoagulant retinopathy)[J]. Ophthalmology, 1989, 96(6): 896-904.
[14]
Asherson RA, Khamashta MA, Gil A, et al. Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome[J]. Am J Med, 1989, 86(4): 391-399.
[15]
Ali O, Slagle WS, Hamp AM. Case report: branch retinal vein occlusion and primary antiphospholipid syndrome[J]. Optometry. 2011, 82(7): 428-433.
[16]
Korematsu S, Goto H, Gotoh C, et al. Central retinal vein occlusion in a pediatric patient with SLE and antiphospholipid antibodies without anti-cardiolipin or anti-β2 glycoprotein I antibodies[J]. BMC Pediatr, 2014, 14: 116.
[17]
Paccalin M, Manic H, Bouche G, et al. Antiphospholipid syndrome in patients with retinal venous occlusion[J]. Thromb Res, 2006, 117(4): 365-369.
[18]
宋佳,孙淑艳.非诊断标准抗磷脂抗体的研究进展[J].中国实验诊断学202024(4):694-697.
[19]
Giordano N, Senesi M, Battisti E, et al. Antiphospholipid antibodies in patients with retinal vascular occlusions[J]. Acta Ophthalmol Scand, 1998, 76(1): 128-129.
[20]
Hartnett ME, Laposata M, van-Cott E. Antiphospholipid antibody syndrome in a six-year-old female patient[J]. Am J Ophthalmol, 2003, 135(4): 542-544.
[21]
Miserocchi E, Baltatzis S, Foster CS. Ocular features associated with anticardiolipin antibodies: a descriptive study[J]. Am J Ophthalmol, 2001, 131(4): 451-456.
[22]
Suvajac G, Stojanovich L, Milenkovich S. Ocular manifestations in antiphospholipid syndrome[J]. Autoimmun Rev, 2007, 6(6): 409-414.
[23]
Ben-Brahim M, Arfa S, Boubaker F, et al. Case Report: Recurrent retinal vein occlusion as the first clinical manifestation of systemic lupus erythematosus in a male patient[J]. F1000Res, 2021, 10: 761.
[24]
Demirci FY, Küçükkaya R, Akarçay K, et al. Ocular involvement in primary antiphospholipid syndrome: Ocular involvement in primary APS[J]. Int Ophthalmol, 1998, 22(6): 323-329.
[25]
Abegg M, Tappeiner C, Wolf-Schnurrbusch U, et al. Treatment of branch retinal vein occlusion induced macular edema with bevacizumab[J]. BMC Ophthalmol, 2008, 8: 18.
[26]
Cekiç O, Chang S, Tseng JJ, et al. Intravitreal triamcinolone injection for treatment of macular edema secondary to branch retinal vein occlusion[J]. Retina, 2005, 25(7): 851-855.
[27]
Chaturvedi S, McCrae KR. Diagnosis and management of the antiphospholipid syndrome[J]. Blood Rev, 2017, 31(6): 406-417.
[28]
Agarwal M, Biswas J. Central retinal vein occlusion in primary antiphospholipid antibody syndrome[J]. Retin Cases Brief Rep, 2009, 3(3): 293-295.
[29]
Kent D, Hickey-Dwyer M, Clark D. Long-term follow-up of ischaemic retinopathy in the antiphospholipid syndrome with lupus-like disease[J]. Eye, 2000, 14(3): 313-317.
[30]
Querques L, Terrada C, Souied EH, et al. Bilateral sequential central retinal vein occlusion associated with primary antiphospholipid syndrome[J]. J Fr Ophtalmol, 2012, 35(6): 443.
[31]
Wiechens B, Schröder JO, Pötzsch B, et al. Primary antiphospholipid antibody syndrome and retinal occlusive vasculopathy[J]. Am J Ophthalmol, 1997, 123(6): 848-850.
[32]
Gelman R, Tsang SH. Sequential central retinal vein and ophthalmic artery occlusions in a pediatric case of primary antiphospholipid syndrome[J]. Retin Cases Brief Rep, 2016, 10(1): 58-62.
[33]
Asherson RA, Cervera R, Piette JC, et al. Catastrophic antiphospholipid syndrome. Clinical and laboratory features of 50 patients[J]. Medicine (Baltimore), 1998, 77(3): 195-207.
[34]
Trojet S, Loukil I, El-Afrit MA, et al. Bilateral retinal vascular occlusion during antiphospholipid antibody syndrome: a case report[J]. J Fr Ophtalmol, 2005, 28(5): 503-507.
[35]
中华医学会风湿病学分会. 抗磷脂综合征诊断和治疗指南[J].中华风湿病学杂志201115(6):407-410.
[36]
Au A, O′Day J. Review of severe vaso-occlusive retinopathy in systemic lupus erythematosus and the antiphospholipid syndrome: associations, visual outcomes, complications and treatment[J]. Clin Exp Ophthalmol, 2004, 32(1): 87-100.
[37]
Koch JW, al-Nawaiseh I, Koch FH. Severe occlusive bilateral retinal vasculitis within the scope of seronegative systemic lupus erythematosus[J]. Klin Monbl Augenheilkd, 1992, 201(5): 330-336.
[38]
Neumann R, Foster CS. Corticosteroid-sparing strategies in the treatment of retinal vasculitis in systemic lupus erythematosus[J]. Retina, 1995, 15(3): 201-212.
[39]
Snyers B, Lambert M, Hardy JP. Retinal and choroidal vaso-occlusive disease in systemic lupus erythematosus associated with antiphospholipid antibodies[J]. Retina, 1990, 10(4): 255-260.
[40]
Giorgi D, Pace F, Giorgi A, et al. Retinopathy in systemic lupus erythematosus: pathogenesis and approach to therapy[J]. Hum Immunol, 1999, 60(8): 688-696.
[41]
Glacet-Bernard A, Kuhn D, Vine AK, et al. Treatment of recent onset central retinal vein occlusion with intravitreal tissue plasminogen activator: a pilot study[J]. Br J Ophthalmol, 2000, 84(6): 609-613.
[42]
Moreno-Páramo D, Rayón-Rodríguez MA, García-Leonardo JI. Combined central retinal artery and vein occlusion; first manifestation of lupus in a pediatric patient[J]. Arch Soc Esp Oftalmol (Engl Ed), 2019, 94(3): 141-144.
[43]
Al-Latayfeh M, Silva PS, Sun JK, et al. Antiangiogenic therapy for ischemic retinopathies[J]. Cold Spring Harb Perspect Med, 2012, 2(6): a006411.
[44]
Fitzpatrick EP, Chesen N, Rahn EK. The lupus anticoagulant and retinal vaso-occlusive disease[J]. Ann Ophthalmol, 1990, 22(4): 148-152.
[45]
Hwang HS, Kang S. Combined central retinal vein and artery occlusion in systemic lupus erythematosus patient[J]. Retin Cases Brief Rep, 2012, 6(2): 187-188.
[46]
Parchand SM, Vijitha VS, Misra DP. Combined central retinal artery and vein occlusion in lupus[J]. BMJ Case Rep, 2017: 218848.
[47]
Lu BW, Xie LK, Hao XF, et al. Combined central retinal artery and vein occlusion associated with primary antiphospholipid syndrome treated by injection of dexamethasone intravitreal implant and anticoagulant therapy: a case report[J]. Int J Ophthalmol, 2022, 15(6): 1027-1029.
[48]
Cekiç O, Chang S, Tseng JJ, et al. Intravitreal triamcinolone injection for treatment of macular edema secondary to branch retinal vein occlusion[J]. Retina, 2005, 25(7): 851-855.
[49]
Joäo MD, Costa JV, Santos GC, et al. Retinal vein and artery occlusion as the first manifestation of primary antiphospholipid syndrome in a pediatric patient [J]. Arq Bras Oftalmol, 2022: 8207.
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