Kutteh W H, Rote N S, Silver R
Department of Obstetrics and Gynecology, University of Tennessee, Health Science Center, Memphis 38163-2116, USA.
Am J Reprod Immunol. 1999 Feb;41(2):133-52. doi: 10.1111/j.1600-0897.1999.tb00087.x.
In women who have a diagnosis of APS (both clinical and laboratory criteria) the chance for successful pregnancy is reduced. In these cases, treatment appears to be a clear option, particularly in the case of prior thromboembolic events. The current preference of treatment for women with RPL and aPL antibodies is subcutaneous heparin and aspirin. This treatment should begin with a positive pregnancy test and continue postpartum. It is unclear, at this time, what treatment, if any, is required for women who do not meet all the criteria for diagnosis of APS, but who are known to have aPL antibodies. In some cases, these women were tested because of a prior false-positive test for syphilis, with subsequent identification of aPL antibodies. More recently, women undergoing IVF were tested and found to have an increased incidence of aPL antibodies. It was suggested that aPL antibodies are associated with infertility and failure to implant. However, a summary of published reports indicate that positive aPL antibodies in patients undergoing IVF do not influence ongoing pregnancy rates. This subject, however, remains an area of active investigation because aPL antibodies were shown to interact with the syncytiotrophoblast and cytotrophoblast layers and could, theoretically, after implantation.
对于已诊断为抗磷脂综合征（APS，包括临床和实验室标准）的女性，成功怀孕的几率会降低。在这些情况下，治疗似乎是一个明确的选择，尤其是在既往有血栓栓塞事件的情况下。目前，对于有复发性流产（RPL）和抗磷脂抗体（aPL）的女性，治疗首选皮下注射肝素和阿司匹林。这种治疗应在妊娠试验呈阳性时开始，并持续至产后。目前尚不清楚，对于未满足APS诊断所有标准，但已知有aPL抗体的女性，是否需要进行治疗以及需要何种治疗。在某些情况下，这些女性是因为之前梅毒检测呈假阳性，随后检测出aPL抗体而接受检测的。最近，接受体外受精（IVF）的女性接受检测后发现，aPL抗体的发生率有所增加。有人认为，aPL抗体与不孕和着床失败有关。然而，已发表报告的总结表明，接受IVF的患者中aPL抗体呈阳性并不影响持续妊娠率。然而，由于aPL抗体被证明可与合体滋养层和细胞滋养层相互作用，理论上在着床后也会如此，因此这个问题仍然是一个积极研究的领域。
