Arachchillage Deepa R Jayakody, Machin Samuel J, Mackie Ian J, Cohen Hannah
Dr. Deepa Arachchillage, Haemostasis Research Unit, Department of Haematology, University College London, 1st Floor, 51 Chenies Mews, London WC1E 6HX, UK, Tel.: +44 20 7679 6419, Fax: +44 20 7679 6433, E-mail:
Thromb Haemost. 2015 Jan;113(1):13-9. doi: 10.1160/TH14-05-0416. Epub 2014 Oct 16.
Accurate diagnosis of obstetric antiphospholipid syndrome (APS) is a prerequisite for optimal clinical management. The international consensus (revised Sapporo) criteria for obstetric APS do not include low positive anticardiolipin (aCL) and anti β2 glycoprotein I (aβ2GPI) antibodies (< 99th centile) and/or certain clinical criteria such as two unexplained miscarriages, three non-consecutive miscarriages, late pre-eclampsia, placental abruption, late premature birth, or two or more unexplained in vitro fertilisation failures. In this review we examine the available evidence to address the question of whether patients who exhibit non-criteria clinical and/or laboratory manifestations should be included within the spectrum of obstetric APS. Prospective and retrospective cohort studies of women with pregnancy morbidity, particularly recurrent pregnancy loss, suggest that elimination of aCL and/or IgM aβ2GPI, or low positive positive aCL or aβ2GPI from APS laboratory diagnostic criteria may result in missing the diagnosis in a sizeable number of women who could be regarded to have obstetric APS. Such prospective and retrospective studies also suggest that women with non-criteria obstetric APS may benefit from standard treatment for obstetric APS with low-molecular-weight heparin plus low-dose aspirin, with good pregnancy outcomes. Thus, non-criteria manifestations of obstetric APS may be clinically relevant, and merit investigation of therapeutic approaches. Women with obstetric APS appear to be at a higher risk than other women of pre-eclampsia, placenta-mediated complications and neonatal mortality, and also at increased long-term risk of thrombotic events. The applicability of these observations to outcomes in women with non-criteria obstetric APS remains to be determined.
准确诊断产科抗磷脂综合征（APS）是优化临床管理的前提。产科APS的国际共识（修订版札幌）标准不包括低阳性抗心磷脂（aCL）和抗β2糖蛋白I（aβ2GPI）抗体（<第99百分位数）和/或某些临床标准，如两次不明原因流产、三次非连续流产、晚发型先兆子痫、胎盘早剥、晚期早产或两次或更多次不明原因体外受精失败。在本综述中，我们研究现有证据，以探讨表现出非标准临床和/或实验室表现的患者是否应纳入产科APS范畴的问题。对有妊娠并发症尤其是复发性流产的女性进行的前瞻性和回顾性队列研究表明，从APS实验室诊断标准中剔除aCL和/或IgM aβ2GPI，或低阳性aCL或aβ2GPI，可能会导致大量可能被视为患有产科APS的女性漏诊。此类前瞻性和回顾性研究还表明，患有非标准产科APS的女性可能会从低分子量肝素加小剂量阿司匹林的产科APS标准治疗中获益，妊娠结局良好。因此，产科APS的非标准表现可能具有临床相关性，值得对治疗方法进行研究。患有产科APS的女性似乎比其他女性发生先兆子痫、胎盘介导并发症和新生儿死亡的风险更高，长期发生血栓事件的风险也增加。这些观察结果对非标准产科APS女性结局的适用性仍有待确定。
