Yamada Hideto, Atsumi Tatsuya, Kobashi Gen, Ota Chikako, Kato Emi H, Tsuruga Noriko, Ohta Kaori, Yasuda Shinsuke, Koike Takao, Minakami Hisanori
Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Kita-ku N15 W7, Sapporo 060-8638, Japan.
J Reprod Immunol. 2009 Jan;79(2):188-95. doi: 10.1016/j.jri.2008.11.001. Epub 2009 Feb 10.
Antiphospholipid antibody (aPL) is associated with thromboembolism. There is scant evidence of a relationship between the aPL profile and serious adverse pregnancy outcome. The aim of this study was to assess whether aPL measurements during early pregnancy were useful in predicting a serious adverse pregnancy outcome. In this prospective study, we measured aPLs, including lupus anticoagulant (LA), IgG, IgM, IgA anticardiolipin antibody (aCL), IgG, IgM phosphatidylserine-dependent antiprothrombin antibody, and IgG kininogen-dependent antiphosphatidylethanolamine antibody (aPE) during the first trimester in a consecutive series of 1155 women. The 99 th percentile cut-off values in each aPL were determined using samples from 105 women who did not exhibit any pregnancy morbidity. We assessed the predictive risk of a serious adverse pregnancy outcome adjusted for confounding factors. We found that IgG aCL was associated with developing pregnancy-induced hypertension (PIH) (odds ratio 11.4, 95% CI 2.7-48); IgG aPE with PIH (8.3, 2.4-29), severe PIH (20.4, 4.5-91), and premature delivery (PD) (12.7, 3.1-50); and LA with PD (11.0, 2.8-44) and low birth weight (8.0, 2.1-31). The combinations of IgG aPE plus IgG aCL (17.5, 4.7-66.7) or IgG aPE plus LA (22.2, 5.4-909) measurements predicted severe PIH with 30.8% sensitivity and 99.2% specificity. We conclude that aPL measurements during early pregnancy may be useful in predicting adverse pregnancy outcome.
抗磷脂抗体（aPL）与血栓形成有关。关于aPL谱与严重不良妊娠结局之间的关系，证据很少。本研究的目的是评估孕早期检测aPL是否有助于预测严重不良妊娠结局。在这项前瞻性研究中，我们对连续的1155名女性在孕早期测量了aPL，包括狼疮抗凝物（LA）、IgG、IgM、IgA抗心磷脂抗体（aCL）、IgG、IgM磷脂丝氨酸依赖性抗凝血酶原抗体以及IgG激肽原依赖性抗磷脂酰乙醇胺抗体（aPE）。使用105名未出现任何妊娠并发症的女性样本确定每种aPL的第99百分位数临界值。我们评估了经混杂因素调整后的严重不良妊娠结局的预测风险。我们发现，IgG aCL与妊娠期高血压（PIH）的发生有关（比值比11.4，95%可信区间2.7 - 48）；IgG aPE与PIH（8.3，2.4 - 29）、重度PIH（20.4，4.5 - 91）和早产（PD）（12.7，3.1 - 50）有关；LA与PD（11.0，2.8 - 44）和低出生体重（8.0，2.1 - 31）有关。IgG aPE加IgG aCL（17.5，4.7 - 66.7）或IgG aPE加LA（22.2，5.4 - 909）的联合检测对重度PIH的预测敏感性为30.8%，特异性为99.2%。我们得出结论，孕早期检测aPL可能有助于预测不良妊娠结局。
