Martínez-Zamora M A, Tàssies D, Creus M, Reverter J C, Puerto B, Monteagudo J, Carmona F, Balasch J
Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d' Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Hemotherapy and Hemostasis Unit, Hospital Clínic of Barcelona, Barcelona, Spain.
Hum Reprod. 2016 Jan;31(1):46-52. doi: 10.1093/humrep/dev278. Epub 2015 Nov 2.
Are the levels of circulating cell-derived microparticles (cMPs) in patients with recurrent miscarriage (RM) associated with the antiphospholipid syndrome (APS)?
cMPs in women with RM are not associated with antiphospholipid antibodies (aPLs).
Previous studies have focused on cMP levels in RM patients. Most studies have shown higher levels of cMPs in RM patients whereas others have reported lower levels. Data regarding cMPs in patients with the APS are scanty in the literature.
STUDY DESIGN, SIZE, DURATION: A case-control study including three groups of patients. A total of 154 women were prospectively recruited from September 2009 to October 2013. Four patients refused to participate. The APS group consisted of 50 women that had been previously diagnosed with primary APS and had had ≥3 consecutive first trimester miscarriages. The uRM group included 52 couples with ≥3 consecutive first trimester miscarriages of unknown etiology. The fertile control (FER) group was composed of 52 healthy fertile women with no history of pregnancy losses. Miscarriage was defined as intrauterine pregnancy loss at <10 weeks' size on ultrasound.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Venous blood samples for coagulation studies and cMP determinations were obtained. All patients underwent a thrombophilia study.
cMP levels were significantly higher in the APS and uRM groups versus the FER group (P < 0.0001 and P = 0.009, respectively) (cMP number × 10(3)/ml plasma [mean ± SD]: APS: 18.5 ± 13.6; uRM: 16.3 ± 13.8; FER: 9.7 ± 4.6). There were no statistically significant differences in cMP levels between the APS and uRM groups.
LIMITATIONS, REASONS FOR CAUTION: The sample size was arbitrarily decided according to previous studies analyzing cMPs in RM patients. Different cMP subtypes were not investigated.
The present study adds further data on the subject showing that patients with RM, irrespective of testing positive for aPLs, have increased levels of cMPs compared with healthy fertile controls. The presence of elevated cMPs in RM women may reflect an ongoing systemic pathological, albeit asymptomatic, status that can become deleterious in the setting of pregnancy.
STUDY FUNDING/COMPETING INTERESTS: This study was supported in part by grant from FIS-PI11/01560 within the 'Plan Nacional de I+D+I' and co-funded by the 'ISCIII-Subdirección General de Evaluación' and the 'Fondo Europeo de Desarrollo Regional (FEDER)'. The authors have no competing interests to disclose.
Not applicable.
复发性流产（RM）患者循环中细胞来源的微粒（cMPs）水平是否与抗磷脂综合征（APS）相关？
RM女性患者的cMPs与抗磷脂抗体（aPLs）无关。
既往研究聚焦于RM患者的cMP水平。多数研究显示RM患者的cMP水平较高，而其他研究则报告较低水平。关于APS患者cMPs的文献资料较少。
研究设计、规模、持续时间：一项病例对照研究，包括三组患者。2009年9月至2013年10月前瞻性招募了154名女性。4名患者拒绝参与。APS组由50名先前诊断为原发性APS且有≥3次连续孕早期流产的女性组成。不明原因复发性流产（uRM）组包括52对有≥3次连续孕早期不明原因流产的夫妇。正常生育对照组（FER）由52名无妊娠丢失史的健康有生育能力的女性组成。流产定义为超声检查显示妊娠囊大小<10周时的宫内妊娠丢失。
参与者/材料、环境、方法：采集用于凝血研究和cMP测定的静脉血样本。所有患者均接受了易栓症研究。
APS组和uRM组的cMP水平显著高于FER组（分别为P<0.0001和P = 0.009）（cMP数量×10³/ml血浆[均值±标准差]：APS组：18.5±13.6；uRM组：16.3±13.8；FER组：9.7±4.6）。APS组和uRM组之间的cMP水平无统计学显著差异。
局限性、谨慎理由：样本量根据既往分析RM患者cMPs的研究随意确定。未对不同的cMP亚型进行研究。
本研究为该主题增加了进一步的数据，表明RM患者，无论aPLs检测是否呈阳性，与健康有生育能力的对照组相比，其cMPs水平均升高。RM女性中cMPs升高可能反映了一种持续存在的全身性病理状态，尽管无症状，但在妊娠情况下可能变得有害。
研究资金/利益冲突：本研究部分得到了“国家I+D+I计划”内FIS-PI11/01560的资助，并由“ISCIII - 评估总局”和“欧洲区域发展基金（FEDER）”共同资助。作者没有利益冲突需要披露。
不适用。
