Kaaja R, Julkunen H, Viinikka L, Ylikorkala O
Department I of Obstetrics and Gynecology, University Central Hospital of Helsinki, Finland.
Obstet Gynecol. 1993 Mar;81(3):327-31.
To find out whether the tendency toward poor outcome in lupus pregnancies could be explained by changes in prostacyclin/thromboxane production, to relate these changes to the presence of antiphospholipid antibodies, and to study the potential benefits of low-dose aspirin.
We followed the urinary output of prostacyclin metabolites (6-keto-prostaglandin [PG]F1 alpha, 2,3-dinor-6-keto-PGF1 alpha) and thromboxane metabolites (thromboxane B2, 2,3-dinor-thromboxane B2) using high-pressure liquid chromatography followed by radioimmunoassay. We studied 14 pregnant women with systemic lupus erythematosus (SLE), of whom six had detectable antiphospholipid antibodies. The patients were randomized by a computerized program to receive either 50 mg aspirin daily (six women) or placebo (eight women). Nine healthy pregnant women served as controls.
The production of prostacyclin was normal in early pregnancy in SLE patients but was reduced during late gestation in those without antiphospholipid antibodies. The production of thromboxane was increased in SLE patients compared with controls, and this increase was highest (two-to threefold rise) when antiphospholipid antibodies were detectable. Aspirin eliminated thromboxane dominance without affecting prostacyclin production.
These data suggest that the presence of antiphospholipid antibodies in SLE patients may trigger thromboxane dominance, possibly contributing to the adverse outcome of these pregnancies. This thromboxane dominance can be eliminated with aspirin.
探究狼疮妊娠不良结局的倾向是否可由前列环素/血栓素生成的变化来解释，将这些变化与抗磷脂抗体的存在相关联，并研究低剂量阿司匹林的潜在益处。
我们采用高压液相色谱继以放射免疫分析法追踪前列环素代谢物（6-酮-前列腺素[PG]F1α、2,3-二去甲-6-酮-PGF1α）和血栓素代谢物（血栓素B2、2,3-二去甲-血栓素B2）的尿排泄量。我们研究了14例患有系统性红斑狼疮（SLE）的孕妇，其中6例可检测到抗磷脂抗体。患者通过计算机程序随机分组，分别接受每日50毫克阿司匹林（6例女性）或安慰剂（8例女性）。9名健康孕妇作为对照。
SLE患者妊娠早期前列环素生成正常，但在妊娠晚期，无抗磷脂抗体的患者前列环素生成减少。与对照组相比，SLE患者的血栓素生成增加，当可检测到抗磷脂抗体时，这种增加最为显著（升高两到三倍）。阿司匹林消除了血栓素的优势地位，而不影响前列环素的生成。
这些数据表明，SLE患者中抗磷脂抗体的存在可能引发血栓素优势，这可能是这些妊娠不良结局的原因。阿司匹林可消除这种血栓素优势。
