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北京大学学报（医学版） ›› 2018, Vol. 50 ›› Issue (6): 956-961. doi: 10.19723/j.issn.1671-167X.2018.06.003

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抗磷脂抗体相关性复发性流产的诊治:附75例抗磷脂综合征患者妊娠期用药和结局分析

李欣艺,赵金霞,刘湘源()   

  1. 北京大学第三医院风湿免疫科,北京 100191
  • 收稿日期:2018-07-09 出版日期:2018-12-18 发布日期:2018-12-17
  • 通讯作者: 刘湘源 E-mail:liu-xiangyuan@263.net

Diagnosis and treatment of antiphospholipid antibody:related recurrent spontaneous abortion and analysis of therapeutic drugs and pregnancy outcome in 75 patients with antiphospholipid syndrome

Xin yi LI,Jin xia ZHAO,Xiang yuan LIU()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2018-07-09 Online:2018-12-18 Published:2018-12-17
  • Contact: Xiang yuan LIU E-mail:liu-xiangyuan@263.net

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关键词: 复发性流产, 抗体, 抗磷脂, 治疗结果

Abstract:

Recurrent spontaneous abortion is one of the common complications in women of childbearing age during pregnancy. The immune factor accounts for a large proportion of many causes. Antiphospholipid antibody syndrome is the most common type of acquired thrombophilia disease. Autoimmune di-seases that cause thrombosis and obstetric complications under the action of antibodies are also the most common type of immune-related recurrent abortion. At present, there is no unified opinion on the treatment of this disease, especially the treatment of immunoglobulins and other drugs like glucocorticoid. Here we reviewed the progress of diagnosis and treatment of antiphospholipid antibody-related recurrent abortions and retrospectively analyzed and summarized the drug regimens and pregnancy outcomes of this disease with pregnancy patients in our hospital. A total of 75 patients were included. According to their clinical manifestations and laboratory results, these patients were basically divided into two categories:classical antiphospholipid syndrome and non-classical antiphospholipid syndrome. The latter was further divided into serum-negative antiphospholipid syndrome and antiphospholipid antibody-related recurrent abortion patients based on their clinical manifestations and antiphospholipid antibody results. The patients were divided into four categories:aspirin + hydroxychloroquine, aspirin + low molecular weight heparin, aspirin + low molecular weight heparin + hydroxychloroquine, aspirin + hydroxychloroquine + low molecular weight heparin + low dose glucocorticoids. Among them, aspirin + hydroxychloroquine + low molecular weight heparin + low-dose glucocorticoid treatment regimen was most commonly used. Most of the patients who received the above different treatment regimens achieved full-term infants, and a small number of patients had adverse pregnancy outcomes, such as premature delivery, placental abruption, eclampsia, and fetal malformation. And adverse pregnancy outcomes also occurred in this group. It might be related to the severity of the disease and the potential adverse effects of maternal fetal. However, further statistical analysis is needed for the risk factors affecting the pregnancy outcome of this part of patients.

Key words: Recurrent spontaneous abortion, Antibodies, antiphospholipid, Treatment outcome

中图分类号: 

  • R714.21

表1

IVIG治疗APS或aPL相关的RSA妊娠结局"

Author Sample Type study and treatment Dose of IVIG (per month) Outcomes
Wapner, et al[40] 2 Case report, IVIG, aspirin and heparin after RSA on aspirin / prednisone 1 g/kg Full-term infants
Spinnato, et al[41] 5 Uncontrolled case series, IVIG and variable other treatment Total 2 g/kg 5 live-births, 1 preterm at 32 weeks
Dendrinos, et al[42] 78 Randomized trial, IVIG alone vs. LMWH / aspirin 0.4 g/kg Higher live-birth rate in
LMWH / aspirin group
Chay, et al[43] 1 Case report, IVIG after RSA on LDA and LMWH 0.4 g/kg Full-term infants

表2

经典APS与非经典APS组用药及妊娠结局"

Treatment Classical APS (n=37) Non-classical APS (n=38)
Serum-negative APS aPL related APS
n (%) Outcome n (%) Outcome n (%) Outcome
LDA+LMWH 6 (16.2) Full-term infants (100%) 1 (10) Full-term infants (100%) 8 (28.6) Preterm (12.5%)
LDA+LMWH+
HCQ+GC		 20 (54.1) Full-term infants (55%); placental abruption, eclampsia (30%); deformity (10%); preterm (5%) 4 (40) Full-term infants (75%); preterm (25%) 11 (39.3) Full-term infants (100%)
LDA+HCQ 1 (2.7) Full-term infants (100%) 1 (10) Full-term infants (100%) 1 (3.5) Full-term infants (100%)
LDA+LMWH+
HCQ		 10 (27.0) Full-term infants (80%);
deformity (20%)		 4 (40) Full-term infants (100%) 8 (28.6) Full-term infants (100%)
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CN 11-4691/R
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