From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.
V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University.
J Rheumatol. 2018 Aug;45(9):1263-1272. doi: 10.3899/jrheum.170751. Epub 2018 Jul 15.
Antibodies that recognize the phosphatidylserine/prothrombin complex (antiphosphatidylserine/prothrombin antibodies; aPS/PT) might reveal enhanced thrombotic risk in patients with systemic lupus erythematosus. Little is known about their association with pregnancy complications in the antiphospholipid syndrome (APS).
We enrolled 55 patients with APS who were seeking pregnancy in 2 Italian hospitals. Antiphospholipid antibodies (aPL), including anticardiolipin antibodies, anti-β-glycoprotein I antibodies, lupus-like anticoagulant, and aPS/PT antibodies were assessed, and the patients were prospectively followed for 24 months.
There were 65% (36/55) of the APS patients who had aPS/PT antibodies. Forty-seven pregnancies were followed, including 33 of aPS/PT+ patients. Forty-one of the 47 patients (87%) who initiated a pregnancy eventually gave birth to a child. The pregnancy duration and the mean newborn weight at delivery were significantly lower in aPS/PT+ than in aPS/PT- patients (33.1 ± 4.7 vs 36.2 ± 3.4 wks of gestation, respectively, and 2058 ± 964 g vs 2784 ± 746 g, respectively, p < 0.05). Late pregnancy complications, including intrauterine fetal death, preterm delivery, preeclampsia, and intrauterine growth restriction (IUGR), were more frequent in aPS/PT+ patients, independent of the therapy. Titers of aPS/PT IgG were significantly inversely correlated with the neonatal weight at delivery. Vascular injury, as reflected by thrombosis, fibrinoid necrosis, ischemic and hemorrhagic areas, and presence of chorangiomas characterized the IUGR placentas in the presence of aPS/PT.
The aPS/PT antibodies might represent markers of aPL-related pregnancy complications, IUGR/preeclampsia in particular, and could help identify beforehand patients who may require additional treatment.
识别磷脂酰丝氨酸/凝血酶原复合物的抗体（抗磷脂酰丝氨酸/凝血酶原抗体；aPS/PT）可能揭示系统性红斑狼疮患者的血栓形成风险增加。关于它们与抗磷脂综合征（APS）中妊娠并发症的关系知之甚少。
我们招募了意大利两家医院寻求妊娠的 55 名 APS 患者。评估了抗磷脂抗体（aPL），包括抗心磷脂抗体、抗β-糖蛋白 I 抗体、狼疮样抗凝剂和 aPS/PT 抗体，并对患者进行了为期 24 个月的前瞻性随访。
55 名 APS 患者中有 65%（36/55）存在 aPS/PT 抗体。随访了 47 次妊娠，其中 33 次为 aPS/PT+患者。47 名开始妊娠的患者中有 41 名（87%）最终分娩了一名儿童。aPS/PT+患者的妊娠持续时间和新生儿出生体重明显低于 aPS/PT-患者（分别为 33.1±4.7 周和 36.2±3.4 周，分别为 2058±964 g 和 2784±746 g，p<0.05）。晚期妊娠并发症，包括胎儿宫内死亡、早产、子痫前期和宫内生长受限（IUGR），在 aPS/PT+患者中更为常见，与治疗无关。aPS/PT IgG 滴度与新生儿出生体重呈显著负相关。血管损伤，如血栓形成、纤维蛋白样坏死、缺血和出血区域以及绒毛膜血管瘤的存在，是存在 aPS/PT 的 IUGR 胎盘的特征。
aPS/PT 抗体可能是 aPL 相关妊娠并发症的标志物，特别是 IUGR/子痫前期，并且可以帮助事先识别可能需要额外治疗的患者。
