Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain.
Best Pract Res Clin Obstet Gynaecol. 2012 Feb;26(1):65-76. doi: 10.1016/j.bpobgyn.2011.10.006. Epub 2011 Nov 11.
Antiphospholipid syndrome is characterised by a variety of clinical and immunological manifestations. The clinical hallmarks of this syndrome are thrombosis and poor obstetric outcomes, including miscarriages, fetal loss and severe pre-eclampsia. The main antiphospholipid antibodies include lupus anticoagulant, anticardiolipin and anti-β2-glycoprotein I. The combination of aspirin and heparin is considered the standard of care for women with antiphospholipid syndrome and embryo-fetal losses; however, aspirin in monotherapy may have a place in women with recurrent early miscarriage. A good benefit-risk ratio of low-molecular-weight heparin in pregnancy thrombosis treatment has been reported. Warfarin must be avoided if possible throughout the first trimester of pregnancy. Adequate pregnancy management of women with antiphospholipid syndrome should include co-ordinated medical-obstetrical care, a close follow-up protocol and a good neonatal unit. Close blood pressure control and early detection of proteinuria, together with Doppler studies of the utero-placental circulation should be included in the management protocol.
抗磷脂综合征的特征是多种临床和免疫表现。该综合征的临床特征是血栓形成和不良的产科结局，包括流产、胎儿丢失和严重子痫前期。主要的抗磷脂抗体包括狼疮抗凝物、抗心磷脂抗体和抗β2-糖蛋白 I。阿司匹林和肝素联合应用被认为是抗磷脂综合征和胚胎胎儿丢失妇女的标准治疗方法；然而，阿司匹林单药治疗可能对复发性早期流产的妇女有一定作用。已有报道称，低分子量肝素在妊娠血栓治疗中的获益风险比良好。如果可能，应避免在整个妊娠早期使用华法林。抗磷脂综合征妇女的适当妊娠管理应包括协调的医疗-产科护理、密切的随访方案和良好的新生儿科。管理方案中应包括密切的血压控制和蛋白尿的早期检测，以及子宫胎盘循环的多普勒研究。
