Mihai Bianca-Margareta, Salmen Teodor, Cioca Ana-Maria, Bohîlțea Roxana-Elena
Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania.
Department of Obstetrics and Gynecology, Filantropia Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania.
Diagnostics (Basel). 2023 Jan 31;13(3):512. doi: 10.3390/diagnostics13030512.
Fetal growth restriction is an important part of monitoring a pregnancy. Because guidelines or diagnostic criteria for either minor or major thrombophilia are scarce, this systematic review aims to summarize the present knowledge in the field. We performed the CRD42022376006 protocol in Prospero with a systematic literature search in PubMed and Web of Science databases and included original full-text articles (randomized control trials and clinical trials) from the last 10 years, published in English, and with the "thrombophilia AND (pregnancy OR diagnostic criteria) AND fetal growth restriction" criteria. After two researchers extracted the articles of interest, they were assessed using the Newcastle-Ottawa Scale and eight articles were included. The elements from the thrombophilia diagnostic predict IUGR, factor V Leiden mutation, MTHFR C667T mutation, protein S deficiency, antithrombin deficiency, factor VII polymorphism, and antiphospholipid antibodies, while the association of protein C, PAI-1 and certain combinations of mutations are still under debate and require the collection of more data. The present systematic review provides an extensive picture of the actual knowledge about thrombophilia diagnosis and its links with pregnancy complications, such as intrauterine growth restriction, despite its limitation in the inclusion of other actually debated disorders such as PAI-1 mutation, protein C deficiency and other thrombophilia types.
胎儿生长受限是孕期监测的重要组成部分。由于关于轻度或重度血栓形成倾向的指南或诊断标准稀缺,本系统评价旨在总结该领域的现有知识。我们在国际前瞻性系统评价注册库(Prospero)中执行了CRD42022376006方案,在PubMed和科学网数据库中进行了系统的文献检索,纳入了过去10年发表的英文原创全文文章(随机对照试验和临床试验),且符合“血栓形成倾向与(妊娠或诊断标准)以及胎儿生长受限”的标准。两名研究人员提取感兴趣的文章后,使用纽卡斯尔-渥太华量表进行评估,最终纳入了8篇文章。血栓形成倾向诊断中的因素可预测胎儿宫内生长受限、凝血因子V莱顿突变、亚甲基四氢叶酸还原酶C667T突变、蛋白S缺乏、抗凝血酶缺乏、凝血因子VII多态性和抗磷脂抗体,而蛋白C、纤溶酶原激活物抑制剂-1(PAI-1)以及某些突变组合之间的关联仍存在争议,需要收集更多数据。尽管本系统评价在纳入其他实际存在争议的疾病(如PAI-1突变、蛋白C缺乏和其他血栓形成倾向类型)方面存在局限性,但它提供了关于血栓形成倾向诊断及其与妊娠并发症(如宫内生长受限)之间联系的实际知识的广泛图景。