Pleguezuelo Daniel E, Cabrera-Marante Oscar, Abad Magdalena, Rodriguez-Frias Edgard Alfonso, Naranjo Laura, Vazquez Alicia, Villar Olga, Gil-Etayo Francisco Javier, Serrano Manuel, Perez-Rivilla Alfredo, de la Fuente-Bitaine Laura, Serrano Antonio
Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain.
Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain.
J Clin Med. 2021 May 13;10(10):2094. doi: 10.3390/jcm10102094.
Recurrent pregnancy loss (RPL) affects up to 6% of couples. Although chromosomal aberrations of the embryos are considered the leading cause, 50% of cases remain unexplained. Antiphospholipid Syndrome is a known cause in a few cases. Antiphospholipid antibodies (aPL) anticardiolipin, anti-Beta-2-Glycoprotein-I and Lupus Anticoagulant (criteria aPL) are recommended studies in RPL workup. We tested healthy women with unexplained RPL for criteria aPL and anti-Phosphatidylserine/Prothrombin antibodies (aPS/PT). Patients were classified into three groups according to the number and pregnancy week of RPL: Extra-Criteria (EC), with 2 miscarriages, Early Miscarriage (EM), with ≥3 before pregnancy at week 10 and Fetal Loss (FL), with ≥1 fetal death from pregnancy at week 10. Circulating criteria aPL were absent in 98.1% of EM, 90.9% of FL and 96.6% of EC groups. In contrast, aPS/PT were positive in 15.4% of EM, 15.1% of FL, 16.6% of EC patients and 2.9% in controls. aPS/PT posed a risk for RPL, with an odds ratio of 5.96 (95% confidence interval (CI): 1.85-19.13. = 0.002) for EM, 7.28 (95% CI: 2.07-25.56. = 0.002) for FL and 6.56. (95% CI: 1.77-24.29. = 0.004) for EC. A successful live birth was achieved in all pregnant patients positive for aPS/PT who received treatment with heparin, aspirin and/or hydroxychloroquine.
复发性流产（RPL）影响着高达6%的夫妇。尽管胚胎染色体畸变被认为是主要原因，但仍有50%的病例原因不明。抗磷脂综合征在少数病例中是已知病因。抗磷脂抗体（aPL）抗心磷脂、抗β2糖蛋白I和狼疮抗凝物（标准aPL）是复发性流产检查中推荐的研究项目。我们对原因不明的复发性流产健康女性进行了标准aPL和抗磷脂酰丝氨酸/凝血酶原抗体（aPS/PT）检测。根据复发性流产的次数和孕周，将患者分为三组：额外标准组（EC），有2次流产；早期流产组（EM），妊娠10周前有≥3次流产；胎儿丢失组（FL），妊娠10周后有≥1次胎儿死亡。EM组98.1%、FL组90.9%和EC组96.6%的患者循环标准aPL阴性。相比之下，EM组15.4%、FL组15.1%、EC组16.6%的患者aPS/PT阳性，对照组为2.9%。aPS/PT对复发性流产构成风险，EM组的优势比为5.96（95%置信区间（CI）：1.85 - 19.13，P = 0.002），FL组为7.28（95%CI：2.07 - 25.56，P = 0.002），EC组为6.56（95%CI：1.77 - 24.29，P = 0.004）。所有接受肝素、阿司匹林和/或羟氯喹治疗的aPS/PT阳性孕妇均成功分娩活婴。
