Boffa M-C, Lachassinne E
Service d'Hématologie, Hopital Jean Verdier, Assistance publique, Hospitaux de Paris, Bondy, France.
Lupus. 2007;16(8):634-41. doi: 10.1177/0961203307079039.
Perinatal thrombosis in infants born to mothers with antiphospholipid antibodies (aPL) is a rare event, but with risk of death or severe sequelae. We analysed 16 infants with such perinatal thrombosis reported in the literature in the last 20 years. Thromboses were arterial (13/16), mostly strokes (8/16). Hydrops fetalis with left renal vein thrombosis was associated to a lupus anticoagulant (LA) present only in the child. Risk factors additional to aPL: either prenatal (preeclampsia and/or intra-uterine growth retardation) or perinatal (asphyxia, sepsis, arterial or venous catheter and congenital thrombophilia) were present (one to four of them) in nine out of the 14 evaluable babies. aPL were the only risk factor found in five full term babies who suffered from stroke in four cases and from renal thrombosis in another. Eleven of these infants with aPL in their serum presented a neonatal APS with the same antibody (LA or aCL IgG) found in neonates and their mothers, while the other infants had thrombosis with aPL only in their mother's blood. aCL IgM was only found in one neonate who suffered from sepsis. Thrombosis treatments were diverse. This analysis suggests that women with aPL should be investigated for other thrombophilic risk factors and that aPL should be detected systematically at birth in the offspring of mothers with APS.
患有抗磷脂抗体（aPL）的母亲所生婴儿发生围产期血栓形成是一种罕见事件，但存在死亡或严重后遗症的风险。我们分析了过去20年文献中报道的16例此类围产期血栓形成的婴儿。血栓形成以动脉血栓为主（13/16），主要为中风（8/16）。胎儿水肿合并左肾静脉血栓形成与仅在患儿体内存在的狼疮抗凝物（LA）有关。除aPL外的危险因素：产前（子痫前期和/或宫内生长受限）或围产期（窒息、败血症、动静脉导管和先天性血栓形成倾向）在14例可评估婴儿中有9例存在（1至4种）。aPL是5例足月婴儿中唯一发现的危险因素，其中4例发生中风，另1例发生肾血栓形成。这些血清中有aPL的婴儿中，11例出现新生儿抗磷脂综合征（APS），其体内的抗体（LA或抗心磷脂IgG）与新生儿及其母亲体内的相同，而其他婴儿仅在其母亲血液中存在aPL时发生血栓形成。抗心磷脂IgM仅在1例患败血症的新生儿中发现。血栓形成的治疗方法多种多样。该分析表明，对于患有aPL的女性，应检查是否存在其他血栓形成倾向危险因素，并且对于患有APS的母亲的后代，应在出生时系统检测aPL。
