Corosu R, Roma B, Cocola M, Marziali M
I Clinica Ostetrica e Ginecologica, Università degli Studi di Roma La Sapienza, Roma.
Minerva Ginecol. 1998 Jan-Feb;50(1-2):9-13.
The purpose of this study was to verify the frequency of antiphospholipid syndrome in pregnancy associated with fetal wastage and maternal hypertension. The antiphospholipid antibody syndrome is a clinical syndrome of venous and arterial thrombotic events, recurrent pregnancy loss, and thrombocytopenia associated with two autoantibodies: the lupus anticoagulant (LAC) and anticardiolipin antibody (ACA).
A group of 83 pregnant patients with recurrent fetal loss or with maternal hypertension for the presence of autoantibodies has been studied. None of the patients had systemic lupus erythematosus or any other autoimmune disease such as sclerodermia, myasthenia, autoimmune thrombocytopenic purpura. The patients have been divided into two groups: a) 45 women with fetal wastage history; b) 38 women with maternal hypertension.
The prevalence of autoantibodies in the first group reaches 31.1% (14/45 patients). Two of these 14 patients (14.3%) had fetal loss (one with treatment and one without). 12 of this 14 patients (85.7%) had a normal delivery and all with treatment. Two treatment scheme were used in this study: one with aspirin and another with aspirin and prednisone. In the group of 45 patients there were 34 normal deliveries: 27 (79.5%) pregnancies were treated with aspirin and 7 (20.6%) were treated with aspirin and prednisone. There were 11 fetal loss and 9 (81.1%) in patients without treatment and 2 (18.2%) in treated pregnancies. The prevalence of autoantibodies in the second group reaches 21%.
In conclusions, it can be suggested that treatment strategies for the prevention of fetal loss in the antiphospholipid syndrome are warranted because treatment appears to alter fetal outcome favorably.
本研究的目的是验证与胎儿丢失和母亲高血压相关的妊娠抗磷脂综合征的发生率。抗磷脂抗体综合征是一种临床综合征，其特征为静脉和动脉血栓形成事件、复发性流产以及与两种自身抗体相关的血小板减少症，这两种自身抗体分别为狼疮抗凝物（LAC）和抗心磷脂抗体（ACA）。
对一组83名患有复发性胎儿丢失或母亲高血压且存在自身抗体的孕妇进行了研究。所有患者均无系统性红斑狼疮或任何其他自身免疫性疾病，如硬皮病、重症肌无力、自身免疫性血小板减少性紫癜。患者被分为两组：a）45名有胎儿丢失病史的女性；b）38名患有母亲高血压的女性。
第一组中自身抗体的患病率达到31.1%（45名患者中有14名）。这14名患者中有2名（14.3%）发生了胎儿丢失（一名接受了治疗，一名未接受治疗）。这14名患者中有12名（85.7%）顺产，且均接受了治疗。本研究使用了两种治疗方案：一种是使用阿司匹林，另一种是使用阿司匹林和泼尼松。在45名患者组中，有34例顺产：27例（79.5%）妊娠使用阿司匹林治疗，7例（20.6%）使用阿司匹林和泼尼松治疗。有11例胎儿丢失，未治疗的患者中有9例（81.1%），接受治疗的妊娠中有2例（18.2%）。第二组中自身抗体的患病率达到21%。
总之，可以认为抗磷脂综合征中预防胎儿丢失的治疗策略是有必要的，因为治疗似乎能有利地改变胎儿结局。
