Reproductive Medicine, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL 60061, USA.
Am J Reprod Immunol. 2013 Jun;69(6):596-607. doi: 10.1111/aji.12114. Epub 2013 Mar 25.
Antiphospholipid antibodies (aPL) have been associated with recurrent pregnancy losses (RPL) and other obstetrical complications. The diagnostic criteria for the classical antiphospholipid antibody syndrome (APS) have been utilized for the detection of obstetrical APS in women with RPL. However, laboratory findings and immunopathology of obstetrical APS are significantly different from those of classical APS. In addition, many women with RPL who have positive aPL do not have symptoms consistent with the current APS criteria. The induction of a proinflammatory immune response from trophoblasts and complement activation by aPL rather than thromboembolic changes has been reported as a major immunopathological feature of obstetrical APS. Heparin treatment has been reported to be effective in prevention of early pregnancy loss with APS but not for the late pregnancy loss or complications. The complex effects of heparin may explain the limited efficacy of heparin treatment in RPL. New diagnostic criteria for obstetrical APS are needed urgently, and new therapeutic approaches should be explored further.
抗磷脂抗体 (aPL) 与复发性妊娠丢失 (RPL) 和其他产科并发症有关。用于检测 RPL 妇女产科抗磷脂抗体综合征 (APS) 的经典抗磷脂抗体综合征 (APS) 的诊断标准。然而，产科 APS 的实验室发现和免疫病理学与经典 APS 有显著不同。此外，许多 RPL 妇女的 aPL 呈阳性，但没有与当前 APS 标准一致的症状。已报道由 aPL 诱导的滋养细胞的促炎免疫反应和补体激活而不是血栓栓塞变化是产科 APS 的主要免疫病理学特征。肝素治疗已被报道可有效预防 APS 的早期妊娠丢失，但对晚期妊娠丢失或并发症无效。肝素治疗的复杂作用可能解释了肝素治疗在 RPL 中的有限疗效。迫切需要新的产科 APS 诊断标准，应进一步探索新的治疗方法。
