Ginsberg J S, Brill-Edwards P, Johnston M, Denburg J A, Andrew M, Burrows R F, Bensen W, Cividino A, Long A A
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Blood. 1992 Aug 15;80(4):975-80.
To determine whether an association exists between the presence of antiphospholipid antibodies and pregnancy loss, a cross-sectional study was performed. Consecutive women who were referred to three outpatient rheumatology clinics and who had systemic lupus erythematosus (SLE) and a history of one or more pregnancies were evaluated. Patients were interviewed to determine outcomes of all previous pregnancies. Blood was taken on two separate occasions at least 3 months apart to test for the presence of the lupus anticoagulant and anticardiolipin antibodies; on both occasions, five tests of the lupus anticoagulant, with well-defined normal ranges, and an enzyme-linked immunosorbent assay to measure IgG anticardiolipin antibodies were performed. Patients were considered to be positive for the lupus anticoagulant if one or more tests was abnormal on both occasions and positive for anticardiolipin antibodies if the test was abnormal on both occasions. Forty-two women were studied. Statistically significant associations were shown between lupus anticoagulant positivity and previous pregnancy loss (odds ratio [OR], 4.8; 95% confidence intervals [CI], 1.0 to 23.6; P = .05) and between anticardiolipin antibody positivity and previous pregnancy loss (OR, 20.0; 95% CI, 1.3 to 97.0; P = .01). All seven women with multiple episodes of pregnancy loss were lupus anticoagulant positive and four of these were also anticardiolipin antibody positive. If patients who are transiently positive for lupus anticoagulant and/or anticardiolipin antibodies are considered to be test positive, the associations with pregnancy loss are no longer statistically significant. Within the group of lupus anticoagulant-positive patients, we observed stronger associations between the presence of six or more positive tests and pregnancy loss than between the presence of two to five positive tests and pregnancy loss. No single test for the lupus anticoagulant provides a statistically significant association with pregnancy loss. The results of our study show that by performing multiple lupus anticoagulant tests and by repeating testing for lupus anticoagulant and anticardiolipin antibodies on more than one occasion, significant associations between the presence of antiphospholipid antibodies and previous pregnancy loss can be shown in patients with SLE.
为了确定抗磷脂抗体的存在与妊娠丢失之间是否存在关联，进行了一项横断面研究。对连续转诊至三家门诊风湿病诊所、患有系统性红斑狼疮（SLE）且有一次或多次妊娠史的女性进行了评估。对患者进行访谈以确定既往所有妊娠的结局。在至少间隔3个月的两个不同时间采集血液，检测狼疮抗凝物和抗心磷脂抗体的存在情况；在这两个时间点，均进行了五项狼疮抗凝物检测（具有明确的正常范围）以及一项用于测量IgG抗心磷脂抗体的酶联免疫吸附测定。如果在两个时间点上一项或多项检测异常，则患者被认为狼疮抗凝物阳性；如果在两个时间点上检测均异常，则患者被认为抗心磷脂抗体阳性。共研究了42名女性。结果显示，狼疮抗凝物阳性与既往妊娠丢失之间存在统计学显著关联（优势比[OR]为4.8；95%置信区间[CI]为1.0至23.6；P = 0.05），抗心磷脂抗体阳性与既往妊娠丢失之间也存在统计学显著关联（OR为20.0；95%CI为1.3至97.0；P = 0.01）。所有7名有多次妊娠丢失的女性狼疮抗凝物均为阳性，其中4名抗心磷脂抗体也为阳性。如果将狼疮抗凝物和/或抗心磷脂抗体短暂阳性的患者视为检测阳性，那么与妊娠丢失的关联不再具有统计学显著性。在狼疮抗凝物阳性的患者组中，我们观察到六项或更多阳性检测结果与妊娠丢失之间的关联比两项至五项阳性检测结果与妊娠丢失之间的关联更强。没有一项狼疮抗凝物检测与妊娠丢失存在统计学显著关联。我们的研究结果表明，通过进行多次狼疮抗凝物检测以及在多个时间点重复检测狼疮抗凝物和抗心磷脂抗体，可以在SLE患者中显示抗磷脂抗体的存在与既往妊娠丢失之间的显著关联。
