Department of Internal Medicine, Zala County Hospital, Zalaegerszeg, Hungary.
Hum Immunol. 2012 Jul;73(7):726-31. doi: 10.1016/j.humimm.2012.04.003. Epub 2012 Apr 28.
Of the systemic autoimmune diseases that lead to sterility/infertility, antiphospholipid syndrome (APS) has an outstanding importance; it may be associated with abortion and premature birth which are included in its diagnostic criteria, as well as preeclampsia, pregnancy-induced hypertension, foetal retardation, miscarriage, stillbirth and sterility. Between 2004 and 2009, on the Department of Immunology in the Zala County Hospital, 100 female patients with sterility (st)/infertility (if) (33/67), (mean age: 34.08 years) underwent, in addition to history taking and physical examination, an assessment by immune-serologic tests (ANA, anti-dsDNA, ENA-Profile, anti-TPO, a-sperm, aCL, aPS, aβ2GP1, aANX, and aPT). Positive aCL on two occasions could be demonstrated in 27/100 cases (27%) (st/if: 7/20). Among them 4 cases of primary APS have been diagnosed respectively. In the remaining 17 patients the clinical picture did not fulfil criteria. In addition to the twofold positive aCL, unusual antiphospholipid antibodies including aβ2GP1, aPS or both were present in 1/27, 2/27 and 1/27 patients, as well as aANX and aPT in 3/26 and 1/27 patients respectively. One-time positive aCL occurred in 16/100 women (16%) (st/if: 5/11); among them aPT and aβ2GP1 could be detected in 1/16 patient each. Based on the clinical picture, we raised the possibility of primary APS in 2/16 patients. Among the aCL-negative women, we found the unusual antibodies of APS in 8/57 patients (14%) including positivity of aβ2GP1, aPS, aPT and aANX in 4/57, 4/57, 2/57 and 3/57 patients respectively; taking the clinical criteria of APS into consideration, primary APS could be stated in 2/57 patients of them. The 32 pregnancies developed in the follow-up period upon administration of acetylsalicylic acid (ASA) and maintenance dose low molecular weight heparin (LMWH), together with prednisolone in patients with secondary APS, resulted in 23 deliveries and 5 miscarriages; 4 pregnancies are currently in progress. The results of our investigations highlight the significance of demonstrating latent autoimmune diseases in female patients with sterility/infertility, as barrenness can be terminated by the appropriate treatment of these conditions.
在导致不孕/不育的系统性自身免疫性疾病中，抗磷脂综合征（APS）具有重要意义；它可能与流产和早产有关，这些都包含在其诊断标准中，此外还有子痫前期、妊娠高血压、胎儿发育迟缓、流产、死产和不孕。在 2004 年至 2009 年间，扎拉县医院免疫科对 100 名不孕/不育女性（33/67）（平均年龄：34.08 岁）进行了病史询问和体格检查，此外还进行了免疫血清学检查（ANA、抗 dsDNA、ENA-Profile、抗 TPO、a-精子、aCL、aPS、aβ2GP1、aANX 和 aPT）。在 100 例患者中，有 27 例（27%）（st/if：7/20）两次检测到阳性 aCL。其中，4 例被诊断为原发性 APS。在其余 17 例患者中，临床症状不符合标准。除了两次阳性 aCL，还有 1/27、2/27 和 1/27 例患者出现不常见的抗磷脂抗体，包括 aβ2GP1、aPS 或两者均有，3/26 和 1/27 例患者出现 aANX 和 aPT。16 例女性（16%）（st/if：5/11）一次检测到阳性 aCL；其中，1/16 例患者可检测到 aPT 和 aβ2GP1。根据临床症状，我们怀疑 2 例患者为原发性 APS。在 aCL 阴性的女性中，我们发现 8 例（14%）患有 APS 不常见抗体，包括 4 例（4/57）、4 例（4/57）、2 例（2/57）和 3 例（3/57）患者的 aβ2GP1、aPS、aPT 和 aANX 阳性；考虑到 APS 的临床标准，其中 2 例（2/57）患者可诊断为原发性 APS。在接受乙酰水杨酸（ASA）和维持剂量低分子量肝素（LMWH）以及继发性 APS 患者的泼尼松龙治疗后，在随访期间有 32 例妊娠，其中 23 例分娩，5 例流产；目前有 4 例妊娠正在进行中。我们的研究结果强调了在不孕/不育女性中检测潜在自身免疫性疾病的重要性，因为这些疾病可以通过适当的治疗得到治愈。
