Amengual O, Fujita D, Ota E, Carmona L, Oku K, Sugiura-Ogasawara M, Murashima A, Atsumi T
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki City, Osaka, Japan.
Lupus. 2015 Oct;24(11):1135-42. doi: 10.1177/0961203315578765. Epub 2015 Mar 25.
Obstetric complications are common in patients with antiphospholipid syndrome. However, the impact of antiphosholipid antibodies (aPL) in the pregnancy outcomes of asymptomatic aPL carriers is uncertain. The aim of this systematic review is to assess whether primary prophylaxis is beneficial to prevent obstetric complications during pregnancy in asymptomatic women positive for aPL who have no history of recurrent pregnancy loss or intrauterine fetal death.
Studies evaluating the effect of prophylactic treatment versus no treatment in asymptomatic pregnant aPL carriers were identified in an electronic database search. Design, population and outcome homogeneity of studies was assessed and meta-analysis was performed. The pooled Mantel-Haenszel relative risk of specific pregnancy outcomes was obtained using random effects models. Heterogeneity was measured with the I(2) statistic. All analyses were conducted using Review Manager 5.3.
Data from five studies involving 154 pregnancies were included and three studies were meta-analysed. The risk ratio and 95% confidence interval (CI) of live birth rates, preterm birth, low birth weight and overall pregnancy complications in treated and untreated pregnancies were 1.14 (0.18-7.31); 1.71 (0.32-8.98); 0.98 (0.07-13.54) and 2.15 (0.63-7.33),respectively. Results from the meta-analysis revealed that prophylactic treatment with aspirin is not superior to placebo to prevent pregnancy complications in asymptomatic aPL carriers.
This systematic review did not find evidence of the superiority of prophylactic treatment with aspirin compared to placebo or usual care to prevent unfavourable obstetric outcomes in otherwise healthy women with aPL during the first pregnancy.
产科并发症在抗磷脂综合征患者中很常见。然而，抗磷脂抗体（aPL）对无症状aPL携带者妊娠结局的影响尚不确定。本系统评价的目的是评估对于既往无复发性流产或宫内胎儿死亡史、aPL检测呈阳性的无症状女性，初级预防措施对预防孕期产科并发症是否有益。
通过电子数据库检索，找出评估无症状aPL携带者预防性治疗与不治疗效果的研究。评估研究的设计、人群和结局同质性，并进行荟萃分析。使用随机效应模型获得特定妊娠结局的合并Mantel-Haenszel相对风险。用I(2)统计量测量异质性。所有分析均使用Review Manager 5.3进行。
纳入了五项涉及154例妊娠的研究数据，其中三项研究进行了荟萃分析。治疗组和未治疗组活产率、早产、低出生体重和总体妊娠并发症的风险比及95%置信区间（CI）分别为1.14（0.18 - 7.31）；1.71（0.32 - 8.98）；0.98（0.07 - 13.54）和2.15（0.63 - 7.33）。荟萃分析结果显示，对于无症状aPL携带者，阿司匹林预防性治疗在预防妊娠并发症方面并不优于安慰剂。
本系统评价未发现证据表明，对于首次妊娠的、aPL检测呈阳性的健康女性，与安慰剂或常规护理相比，阿司匹林预防性治疗在预防不良产科结局方面具有优越性。
