Maesawa Yoko, Deguchi Masashi, Tanimura Kenji, Morizane Mayumi, Ebina Yasuhiko, Yamada Hideto
Department of Obstetrics and Gynecology Kobe University Graduate School of Medicine Kobe Japan.
Reprod Med Biol. 2018 Jan 1;17(2):149-154. doi: 10.1002/rmb2.12080. eCollection 2018 Apr.
This study aimed to assess the efficacy of high-dose i.v. immunoglobulin (HIVIg) therapy in pregnant women with antiphospholipid syndrome (APS) secondary to systemic lupus erythematosus with a history of pregnancy failure, despite receiving low-dose aspirin plus unfractionated heparin therapy, of which condition being designated as "aspirin-heparin-resistant APS" (AHRAPS).
The HIVIg therapy (20 g/d, 5 days) was performed for the pregnancies of five women with AHRAPS.
Five of the eight pregnancies ended in live births. The gestational ages of delivery in four of the five pregnancies were extended, compared with previous pregnancies. The HIVIg therapy was considered to be successful for these four pregnancies. Excluding one pregnancy that ended in miscarriage with an abnormal chromosome karyotype of the villi, the HIVIg therapy was considered to be successful in four (57.1%) of the seven pregnancies of the women with AHRAPS. Although all the live newborns were prematurely delivered, no adverse effect of the HIVIg therapy was observed.
The HIVIg therapy might be beneficial as an immune modifier for pregnant women with AHRAPS. However, the precise indication of which women with AHRAPS who should receive HIVIg therapy remains unknown.
本研究旨在评估大剂量静脉注射免疫球蛋白（HIVIg）疗法对患有继发于系统性红斑狼疮的抗磷脂综合征（APS）且有妊娠失败史的孕妇的疗效，尽管这些孕妇已接受低剂量阿司匹林加普通肝素治疗，这种情况被称为“阿司匹林 - 肝素抵抗性APS”（AHRAPS）。
对5例AHRAPS孕妇的妊娠进行了HIVIg治疗（20 g/d，共5天）。
8次妊娠中有5次以活产告终。与前次妊娠相比，5次妊娠中有4次的分娩孕周延长。这4次妊娠的HIVIg治疗被认为是成功的。排除1例因绒毛染色体核型异常而流产的妊娠，AHRAPS女性的7次妊娠中有4次（57.1%）的HIVIg治疗被认为是成功的。尽管所有存活新生儿均为早产，但未观察到HIVIg治疗的不良反应。
HIVIg疗法作为一种免疫调节剂，可能对AHRAPS孕妇有益。然而，哪些AHRAPS女性应接受HIVIg治疗的确切指征仍不清楚。
