根据全球抗磷脂综合征评分，抗磷脂抗体阳性的女性妊娠成功率及肝素和/或阿司匹林的反应有所不同。
Pregnancy success rate and response to heparins and/or aspirin differ in women with antiphospholipid antibodies according to their Global AntiphosPholipid Syndrome Score.
机构信息
Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy; School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
Department of Thrombosis and Haemophilia, Guy's and St Thomas' Hospital, London, United Kingdom; Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University, Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
出版信息
Semin Arthritis Rheum. 2020 Jun;50(3):553-556. doi: 10.1016/j.semarthrit.2020.01.007. Epub 2020 Jan 28.
BACKGROUND
The current treatment to prevent pregnancy morbidity (PM) associated with antiphospholipid antibodies (aPL) is based on the use of low dose aspirin and low molecular weight heparin (henceforth defined as standard of care (SoC) treatment). Despite the SoC, up to 30% of women with aPL continue to have pregnancy complications. The global antiphospholipid syndrome (APS) score (GAPSS) is a tool to quantify the risk for the aPL-related clinical manifestations. In this study, we investigated the individual clinical response to SoC in women with aPL after stratifying them according to their GAPSS.
METHODS
One-hundred-fourty-three women (352 pregnancies) with aPL ever pregnant treated with SoC therapy were included. The patients GAPSS was then grouped according to the patients' GAPSS into low risk (< 6), medium risk (6-11), and high risk (≥12).
RESULTS
The live birth rate was 70.5% (248 out of the 352 pregnancies), 45 patients (31%) experienced at least one event of PM, defined as early or late. Patients were stratified according to GAPSS values, in order to identify a low risk group (GAPSS <6, n = 72), a medium risk group (GAPSS 6-11, n = 66) and a high risk group (GAPSS ≥12, n = 5). When considering patients who ever experienced any PM while treated with SoC, all patients in the high risk group experienced PM, while patients in the medium group had a significant higher rate of PM when compared to the low risk group [29 (43.9%) patients V.s. 11 (15.3%), respectively; p < 0.001]. When analysing the number of pregnancies in the three groups, patients in the high risk group had significantly lower live birth rates, when compared to the other groups [11 (40.7%) live births vs. 100 (62.1%) and 137 (82.5%), respectively; p < 0.05]. Furthermore, patients with medium risk group also had significantly lower live birth rates, when compared to the lower risk group (p < 0.001).
CONCLUSIONS
GAPSS might be a valuable tool for to identify patients with a higher likelihood of response to SoC.
背景
目前，预防抗磷脂抗体（aPL）相关妊娠发病率（PM）的治疗方法是基于使用低剂量阿司匹林和低分子量肝素（以下定义为标准治疗（SoC））。尽管采用 SoC，仍有高达 30%的 aPL 妇女继续发生妊娠并发症。全球抗磷脂综合征（APS）评分（GAPSS）是一种量化 aPL 相关临床表现风险的工具。在这项研究中，我们根据 GAPSS 将患有 aPL 的妇女分层，以调查她们在接受 SoC 治疗后的个体临床反应。
方法
纳入了 143 名曾经接受 SoC 治疗的患有 aPL 的妊娠妇女（352 次妊娠）。然后，根据患者的 GAPSS 将患者的 GAPSS 分为低风险（<6）、中风险（6-11）和高风险（≥12）。
结果
活产率为 70.5%（248 次妊娠中的 248 次），45 名患者（31%）经历了至少一次 PM 事件，定义为早发性或晚发性。根据 GAPSS 值对患者进行分层，以确定低风险组（GAPSS<6，n=72）、中风险组（GAPSS 6-11，n=66）和高风险组（GAPSS≥12，n=5）。当考虑接受 SoC 治疗时经历任何 PM 的患者时，高风险组的所有患者均经历了 PM，而中风险组的患者与低风险组相比，PM 的发生率显著更高[分别为 29（43.9%）例和 11（15.3%）例；p<0.001]。当分析三组的妊娠次数时，高风险组的活产率明显低于其他两组[分别为 11（40.7%）例和 100（62.1%）例和 137（82.5%）例；p<0.05]。此外，中风险组的患者与低风险组相比，活产率也显著降低（p<0.001）。
结论
GAPSS 可能是一种有价值的工具，可用于识别对 SoC 反应可能性更高的患者。
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