Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China.
Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.
Front Immunol. 2022 Aug 18;13:971005. doi: 10.3389/fimmu.2022.971005. eCollection 2022.
Thrombocytopenia is a common manifestation of antiphospholipid syndrome (APS), and is a main concern for bleeding on the standard treatment of low dose aspirin (LDA) and low molecular weight heparin (LMWH) in obstetric APS (OAPS).
This study assesses the possible relationship between thrombocytopenia during the first trimester and adverse pregnancy outcomes (APOs) in OAPS patients.
A case-control study was conducted at Peking University People's Hospital, Beijing, China. The clinical, immunologic, and pregnancy outcomes of the OAPS patients were collected. Univariate and multivariate logistic regression analyses were applied to assess the relationship between APOs and thrombocytopenia in the first trimester.
A total of 115 participants were included in the analysis. There were no difference on antepartum and postpartum hemorrhage between the two groups. The gestational age in the thrombocytopenia group was less than that in the control group (34.12 ± 8.44 vs. 37.44 ± 3.81 weeks, = 0.002). Hypocomplementemia, double aPL positive, and high titers of anti-β2 glycoprotein I were more frequent in APS patients with thrombocytopenia ( < 0.05). Compared to the control group, thrombocytopenia in the first trimester was correlated with SGA (12.12% vs. 31.25%, = 0.043), premature birth <37 weeks (16.16% vs 43.75%, = 0.010) and intrauterine fetal death (2.02% vs 12.50%, = 0.033). Thrombocytopenia in first-trimester independently increased the risk of preterm birth <37 weeks (OR = 5.40, 95% CI: 1.35-21.53, = 0.02) after adjusting for demographic and laboratory factors. After adding medication adjustments, these factors above become insignificant ( > 0.05). Of note, the number of platelets increased after delivery in 14 thrombocytopenia patients with live fetuses ( = 0.03).
This study demonstrates that thrombocytopenia in the first trimester increases the risks of preterm birth in women with APS. The effective OAPS treatments may improve pregnancy outcomes and not increase the risk of antepartum and postpartum hemorrhage.
血小板减少症是抗磷脂综合征（APS）的常见表现，也是产科 APS（OAPS）中低剂量阿司匹林（LDA）和低分子肝素（LMWH）标准治疗中出血的主要关注点。
本研究评估 OAPS 患者孕早期血小板减少与不良妊娠结局（APO）之间的可能关系。
本病例对照研究在北京北京大学人民医院进行。收集 OAPS 患者的临床、免疫和妊娠结局。采用单因素和多因素 logistic 回归分析评估孕早期 APOs 与血小板减少之间的关系。
共有 115 名参与者纳入分析。两组患者的产前和产后出血无差异。血小板减少组的孕龄小于对照组（34.12±8.44 vs. 37.44±3.81 周， = 0.002）。血小板减少的 APS 患者更常出现低补体血症、双重 aPL 阳性和高抗-β2 糖蛋白 I 滴度（<0.05）。与对照组相比，孕早期血小板减少与 SGA（12.12% vs. 31.25%， = 0.043）、早产<37 周（16.16% vs. 43.75%， = 0.010）和宫内胎儿死亡（2.02% vs. 12.50%， = 0.033）相关。在调整人口统计学和实验室因素后，孕早期血小板减少独立增加早产<37 周的风险（OR=5.40，95%CI：1.35-21.53， = 0.02）。在加入药物调整后，这些因素变得不显著（>0.05）。值得注意的是，在 14 例活胎血小板减少患者中，分娩后血小板计数增加（ = 0.03）。
本研究表明，孕早期血小板减少增加了 APS 女性早产的风险。有效的 OAPS 治疗可能改善妊娠结局，并且不会增加产前和产后出血的风险。
