Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona.
Department of Medicine, Universitat Autònoma, Barcelona.
Rheumatology (Oxford). 2020 Jun 1;59(6):1306-1314. doi: 10.1093/rheumatology/kez419.
To compare clinical features, laboratory data and fetal-maternal outcomes between 1000 women with obstetric APS (OAPS) and 640 with aPL-related obstetric complications not fulfilling Sydney criteria (non-criteria OAPS, NC-OAPS).
This was a retrospective and prospective multicentre study from the European Registry on Obstetric Antiphospholipid Syndrome.
A total of 1650 women with 5251 episodes, 3601 of which were historical and 1650 latest episodes, were included. Altogether, 1000 cases (OAPS group) fulfilled the Sydney classification criteria and 650 (NC-OAPS group) did not. Ten NC-OAPS cases were excluded for presenting thrombosis during follow-up. All cases were classified as category I (triple positivity or double positivity for aPL) or category II (simple positivity). Overall, aPL laboratory categories showed significant differences: 29.20% in OAPS vs 17.96% in NC-OAPS (P < 0.0001) for category I, and 70.8% in OAPS vs 82% in NC-OAPS (P < 0.0001) for category II. Significant differences were observed when current obstetric complications were compared (P < 0.001). However, major differences between groups were not observed in treatment rates, livebirths and thrombotic complications. In the NC-OAPS group, 176/640 (27.5%) did not fulfil Sydney clinical criteria (subgroup A), 175/640 (27.34%) had a low titre and/or non-persistent aPL positivity but did meet the clinical criteria (subgroup B) and 289/640 (45.15%) had a high aPL titre but did not fulfil Sydney clinical criteria (subgroup C).
Significant clinical and laboratory differences were found between groups. Fetal-maternal outcomes were similar in both groups when treated. These results suggest that we could improve our clinical practice with better understanding of NC-OAPS patients.
比较 1000 例产科抗磷脂综合征（OAPS）患者和 640 例不符合悉尼标准的抗磷脂抗体相关产科并发症（非标准 OAPS，NC-OAPS）患者的临床特征、实验室数据和母婴结局。
这是一项来自欧洲产科抗磷脂综合征登记处的回顾性和前瞻性多中心研究。
共纳入 1650 名女性的 5251 个病例，其中 3601 个为历史病例，1650 个为最新病例。共有 1000 例（OAPS 组）符合悉尼分类标准，650 例（NC-OAPS 组）不符合。10 例 NC-OAPS 患者因随访期间发生血栓而被排除。所有病例均分为 I 类（抗磷脂抗体三重阳性或双重阳性）或 II 类（单纯阳性）。总体而言，抗磷脂抗体实验室分类存在显著差异：OAPS 组为 29.20%，NC-OAPS 组为 17.96%（P<0.0001），I 类；OAPS 组为 70.8%，NC-OAPS 组为 82%（P<0.0001），II 类。当前产科并发症的比较也存在显著差异（P<0.001）。然而，两组间的治疗率、活产率和血栓并发症无显著差异。在 NC-OAPS 组中，176/640（27.5%）不符合悉尼临床标准（亚组 A），175/640（27.34%）低滴度和/或非持续性抗磷脂抗体阳性但符合临床标准（亚组 B），289/640（45.15%）高抗磷脂抗体滴度但不符合悉尼临床标准（亚组 C）。
两组间存在显著的临床和实验室差异。两组经治疗后的母婴结局相似。这些结果表明，通过更好地了解 NC-OAPS 患者，我们可以改进临床实践。
