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. 2023 Mar 17;14:1145146. doi: 10.3389/fimmu.2023.1145146. eCollection 2023.
Bleeding complications are recognized as relatively infrequent manifestations of antiphospholipid syndrome (APS), and the safety of antithrombotic therapy during pregnancy is of concern. This study aims to assess the risk factors and possible associations between bleeding complications and adverse pregnancy outcomes (APOs) in patients with APS.
A retrospective cohort study was conducted at the Peking University People's Hospital. The clinical and immunologic features, bleeding complications, treatment, and pregnancy outcomes of patients with APS were collected. Univariate and multivariate logistic regression analyses were applied to assess the associations between APOs and bleeding complications.
A total of 176 participants with obstetric APS were included in the analysis. There were 66 (37.50%) patients with APS with hemorrhage complications and 86 (48.86%) patients with APS with APOs. Mucocutaneous hemorrhage was associated with APOs including fetal death after 12 weeks [odds ratio (OR) = 10.73, 95% confidence interval (CI): 1.61-71.74, p = 0.014], preterm delivery prior to 34 weeks (OR = 8.30, 95% CI: 2.31-29.84, p = 0.001), and small for gestational age (OR = 4.17, 95% CI: 1.22-14.21, p = 0.023) in univariate logistic regression analyses. It also independently associated with preterm delivery prior to 34 weeks (OR = 40.29, 95% CI: 1.45-1121.32, p = 0.030) in multivariate logistic regression analyses. Receiver operating characteristic (ROC) analysis evaluating the accuracy of these factors for preterm delivery prior to 34 weeks showed that the area under ROC curve was 0.871.
The study shows that mucocutaneous hemorrhage may be an indication of the occurrence of APOs in obstetric patients with APS.
出血并发症被认为是抗磷脂综合征（APS）相对罕见的表现，因此，人们关注抗血栓治疗在妊娠期间的安全性。本研究旨在评估 APS 患者出血并发症与不良妊娠结局（APO）之间的风险因素和可能的关联。
本研究在北京人民医院进行了一项回顾性队列研究。收集了 APS 患者的临床和免疫特征、出血并发症、治疗和妊娠结局。应用单因素和多因素逻辑回归分析评估 APO 与出血并发症之间的关联。
共纳入 176 例产科 APS 患者。其中 66 例（37.50%）患者发生 APS 伴出血并发症，86 例（48.86%）患者发生 APS 伴 APO。黏膜皮肤出血与包括 12 周后胎儿死亡[比值比（OR）=10.73，95%置信区间（CI）：1.61-71.74，p=0.014]、34 周前早产（OR=8.30，95%CI：2.31-29.84，p=0.001）和小于胎龄儿（OR=4.17，95%CI：1.22-14.21，p=0.023）在内的 APO 相关。在单因素逻辑回归分析中，它还与 34 周前早产独立相关（OR=40.29，95%CI：1.45-1121.32，p=0.030）。评估这些因素预测 34 周前早产准确性的受试者工作特征（ROC）分析显示，ROC 曲线下面积为 0.871。
研究表明，黏膜皮肤出血可能是产科 APS 患者发生 APO 的一个指征。
