Larosa Maddalena, Le Guern Véronique, Morel Nathalie, Belhocine Mériem, Ruffatti Amelia, Silva Nicolas Martin, Paule Romain, Mouthon Luc, Dreyfus Michel, Piette Jean-Charles, Souchaud-Debouverie Odile, Deneux-Tharaux Catherine, Guettrot-Imbert Gaelle, Tsatsaris Vassilis, Pannier-Metzger Emmanuelle, Murarasu Anne, Doria Andrea, Costedoat-Chalumeau Nathalie
AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France.
Division of Rheumatology, Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Arthritis Res Ther. 2021 May 4;23(1):134. doi: 10.1186/s13075-021-02518-7.
The criteria for antiphospholipid syndrome (APS) include severe preeclampsia and/or placental insufficiency leading to preterm delivery before 34 weeks of gestation, but this APS manifestation has been rarely studied. Thus, we report a series of severe preeclampsia occurred in patients with APS.
We retrospectively analysed data of women with APS (Sydney criteria) who experienced severe preeclampsia with delivery before 34 weeks' gestation between 2000 and 2017 at five French internal medicine departments and one Italian rheumatology unit.
The 40 women had a mean age of 30.5 ± 4.6 years at their first episode of preeclampsia; 21 were nulligravid (52.5%), 12 (30%) had already been diagnosed with APS, and 21 (52.5%) had a triple-positive antiphospholipid (aPL) antibody test. Preeclampsia occurred at a median gestational age of 25.5 weeks (IQR 23-29). It was associated with HELLP in 18 cases (45%), eclampsia in 6 (15%), placental abruption in 3 (7.5%), catastrophic APS in 3 (7.5%), and foetal and neonatal death in 11 and 15 cases. Overall, 14 (35%) children survived, born at a median gestational age of 31 weeks. Among other APS criteria, 16 women (40%) experienced at least one thrombosis, 17 (42.5%) an intrauterine foetal death, and 19 (47.5%) at least one episode of HELLP during follow-up (median 5 years, IQR = 2-8). None had three or more consecutive miscarriages. Notably, 12 women (30%) had systemic lupus erythematosus.
Severe preeclampsia led to high mortality in the offspring. Almost half of these women experienced other APS features, but not three consecutive miscarriages.
抗磷脂综合征（APS）的标准包括重度子痫前期和/或胎盘功能不全导致妊娠34周前早产，但这种APS表现很少被研究。因此，我们报告了一系列发生在APS患者中的重度子痫前期病例。
我们回顾性分析了2000年至2017年间在法国五个内科科室和一个意大利风湿病科就诊的符合悉尼标准的APS女性患者的数据，这些患者经历了重度子痫前期并在妊娠34周前分娩。
40名女性首次发生子痫前期时的平均年龄为30.5±4.6岁；21名未孕（52.5%），12名（30%）已被诊断为APS，21名（52.5%）抗磷脂（aPL）抗体检测呈三阳性。子痫前期发生的中位孕周为25.5周（四分位间距23 - 29周）。18例（45%）与HELLP综合征相关，6例（15%）与子痫相关，3例（7.5%）与胎盘早剥相关，3例（7.5%）与灾难性APS相关，11例和15例分别与胎儿及新生儿死亡相关。总体而言，14名（35%）儿童存活，出生时的中位孕周为31周。在其他APS标准中，16名女性（40%）在随访期间（中位时间5年，四分位间距=2 - 8年）至少经历过一次血栓形成，17名（42.5%）经历过一次宫内胎儿死亡，19名（47.5%）至少经历过一次HELLP综合征发作。无人有三次或更多次连续流产。值得注意的是，12名女性（30%）患有系统性红斑狼疮。
重度子痫前期导致后代高死亡率。这些女性中近一半有其他APS特征，但没有三次连续流产。
