Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
J Reprod Immunol. 2017 Aug;122:21-27. doi: 10.1016/j.jri.2017.08.001. Epub 2017 Aug 4.
The aim of this study was to understand the clinical features of antiphospholipid syndrome (APS)-complicated pregnancies and evaluate risk factors for the adverse pregnancy outcomes. This multicenter study evaluated live-birth rates according to therapy modality for APS and risk factors of pregnancy loss in 81 pregnancies. Risk factors for pregnancy complications, including premature delivery before 34 gestational weeks, hypertensive disorders of pregnancy, thrombocytopenia, and light-for-date neonate, were evaluated in 51 women who received low dose aspirin (LDA) plus unfractionated heparin (UFH) and delivered after 24 GW. The live-birth rate in APS pregnancies with LDA+UFH therapy was 92.6%. A multiple logistic regression analysis demonstrated that LDA+UFH therapy decreased the risk of pregnancy loss (OR 0.13, 95%CI 0.03-0.62), and that a history of pregnancy loss despite LDA+UFH therapy increased the risk of pregnancy loss (OR 8.74, 95%CI 1.69-45.2). LDA therapy prior to pregnancy decreased the risk of premature delivery (OR 0.14, 95%CI 0.03-0.69). Positive tests for two or more anti-phospholipid antibodies increased the risks of premature delivery (OR 9.61, 95%CI 1.78-51.8) and thrombocytopenia (OR 4.90, 95%CI 1.11-21.7). Laboratory findings of low complements increased the risk of hypertensive disorders of pregnancy (OR 12.1, 95%CI 1.61-91.0). Standard therapy yielded high live-birth rates. Positive tests for two or more anti-phospholipid antibodies and low complements were associated with adverse pregnancy outcomes. These results have important implications for clinicians.
本研究旨在了解抗磷脂综合征（APS）合并妊娠的临床特征，并评估不良妊娠结局的危险因素。这项多中心研究评估了 81 例妊娠中根据 APS 治疗方式和妊娠丢失的危险因素的活产率。在接受低剂量阿司匹林（LDA）+未分级肝素（UFH）治疗并在 24 孕周后分娩的 51 名女性中，评估了包括早产（妊娠 34 周前）、妊娠高血压疾病、血小板减少症和小于胎龄儿在内的妊娠并发症的危险因素。APS 妊娠中 LDA+UFH 治疗的活产率为 92.6%。多因素逻辑回归分析表明，LDA+UFH 治疗降低了妊娠丢失的风险（OR 0.13，95%CI 0.03-0.62），而尽管使用 LDA+UFH 治疗仍有妊娠丢失史增加了妊娠丢失的风险（OR 8.74，95%CI 1.69-45.2）。妊娠前 LDA 治疗降低了早产的风险（OR 0.14，95%CI 0.03-0.69）。两种或两种以上抗磷脂抗体阳性检测增加了早产（OR 9.61，95%CI 1.78-51.8）和血小板减少症（OR 4.90，95%CI 1.11-21.7）的风险。低补体的实验室检查结果增加了妊娠高血压疾病的风险（OR 12.1，95%CI 1.61-91.0）。标准治疗可获得较高的活产率。两种或两种以上抗磷脂抗体阳性和低补体与不良妊娠结局相关。这些结果对临床医生具有重要意义。
