al-Momen A K, Moghraby S A, el-Rab M O, Gader A M, al-Balla S R, al-Meshari A A, al-Nuaim L
Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Clin Rheumatol. 1993 Sep;12(3):381-6. doi: 10.1007/BF02231584.
The association of antiphospholipid antibodies (APA) or lupus anticoagulant (LA) and recurrent fetal loss (RFL) is well established; however, the spectrum of pregnancy outcome in relation to various therapeutic approaches versus placebo is unknown. We studied 49 women with RFL, 14 with immune thrombocytopenia (ITP) 13 of whom without a history of RFL, and 32 controls (all in the first trimester of pregnancy) for the presence of APA. Tests for APA were positive in 15/49 women with RFL (30%), 6/14 ITP (43%) and 2/32 controls (6%). Treatment in the APA positive patients consisted of: no treatment for the 8 patients who had no history of RFL (Group A; all 34 previous pregnancies successful), aspirin alone (Group B, 5 patients; all 30 previous pregnancies unsuccessful), aspirin with prednisolone (Group C, 9 patients; 69/80 previous pregnancies unsuccessful), or aspirin, prednisolone and immunoglobulin G for resistant cases (Group D, 4 patients, previously in Group C). 10/11 (90.9%), 3/7 (43%), 7/13 (53.8%) and 4/7 (57.1%) pregnancies were successful in Group A, B, C and D, respectively. There was a total of 19/45 (42%) failures including 3 pregnancies in one patient who failed to respond to all forms of therapy. This open study with small subgroups of patients draws attention to a wide range of pregnancy outcome in women with APA and to the fact that APA may serve only as a marker for a wide range of pathological conditions with variable degrees of disease severity. More studies are, however, needed to explore the real mechanism of RFL in women with APA and RFL, especially those who are resistant to therapy.
抗磷脂抗体（APA）或狼疮抗凝物（LA）与复发性流产（RFL）之间的关联已得到充分证实；然而，与各种治疗方法相对安慰剂相比的妊娠结局范围尚不清楚。我们研究了49例复发性流产女性、14例免疫性血小板减少症（ITP）患者（其中13例无复发性流产病史）以及32名对照者（均处于妊娠早期）是否存在APA。APA检测在15/49例复发性流产女性（30%）、6/14例ITP患者（43%）和2/32例对照者（6%）中呈阳性。APA阳性患者的治疗方案包括：8例无复发性流产病史的患者未接受治疗（A组；既往34次妊娠均成功），单独使用阿司匹林（B组，5例患者；既往30次妊娠均失败），阿司匹林联合泼尼松龙（C组，9例患者；既往80次妊娠中有69次失败），或对于耐药病例使用阿司匹林、泼尼松龙和免疫球蛋白G（D组，4例患者，之前在C组）。A、B、C和D组的妊娠成功率分别为10/11（90.9%）、3/7（43%）、7/13（53.8%）和4/7（57.1%）。总共有19/45（42%）次妊娠失败，其中1例患者的3次妊娠对所有治疗形式均无反应。这项针对小亚组患者的开放性研究提请人们注意APA女性妊娠结局的广泛差异，以及APA可能仅作为多种不同疾病严重程度的病理状况的标志物这一事实。然而，需要更多研究来探索APA和RFL女性复发性流产的真正机制，尤其是那些对治疗耐药的患者。
