抗磷脂抗体持续阳性对不良妊娠发生机率无影响

临床医师

抗磷脂抗体（aPL）在不良妊娠中所起的作用存在争议，aPL持续阳性是否会引起不良妊娠尚不甚明确。为保险起见，很多aPL持续阳性的患者选择进行辅助生殖治疗。其中，部分aPL阳性的患者因其他原因出现过不良妊娠而被误诊为抗磷脂抗体综合征（APS）。

　　为了解aPL持续阳性（两次检测间隔时间>12周）患者（无血栓形成及不良妊娠病史）、APS患者及健康对照者不良妊娠事件的发生率有无差异，来自伦敦国王学院的May Ching等进行了临床研究， 结果发表近期的Rheumatology杂志上。

　　该研究共纳入了2005年1月至2011年7月的73位aPL持续阳性的孕妇和73位未出现过不良妊娠的APS孕妇，以及292位不良妊娠风险较低的孕妇（对照组）。多胎、畸胎、SLE、有血栓形成的APS以及其他有血栓形成倾向的孕妇均排除在外。

　　研究分析了患者的一般情况，aPL的类型以及其他可能影响妊娠结局的因素，如孕妇的年龄、身高、体重，有无吸烟、妊娠史、宫颈功能不全，是否进行了辅助生殖治疗以及妊娠期间的用药等。对所有APS患者、aPL阳性者以及有先兆子痫风险的患者给予阿司匹林治疗。对有静脉血栓栓塞形成风险的孕妇、曾经出现过妊娠后期并发症或经阿司匹林治疗仍出现不良妊娠的APS患者，给予低分子肝素治疗。

　　结果显示，两组患者的一般情况相似，但年轻的对照组孕妇出现的妊娠并发症较少。aPL持续阳性组与APS组患者的aPL类型相似。aPL持续阳性的孕妇出现APS的机率以及胎儿出生时的体重与对照组相似；在排除母亲年龄及其他妊娠并发症等影响因素后结论依然成立。

　　上述研究结果表明，aPL持续阳性并长期服用阿司匹林的患者其不良妊娠发生率与对照组相似。这提示，如无其他危险因素，aPL持续阳性的患者无需进行过密的产前监测或进行妊娠干预。

　　原文阅读：Persistent antiphospholipid antibodies do not contribute to adverse pregnancy outcomes.
　　Abstract
　　OBJECTIVE: To determine whether women with persistent aPL （>12 weeks apart on at least two separate occasions） without a history of thrombosis or adverse pregnancy outcome had the same adverse pregnancy outcomes as those with obstetric APS or unmatched controls.
　　METHODS: This was a case-control study between 2005 and 2011 where we identified 73 women with persistent aPL and coincidentally the same number with obstetric APS. Unmatched controls were identified from low-risk clinics （ratio 1:4）。 Women with multiple pregnancies, fetal anomalies, SLE, thrombotic APS and other thrombophilias were excluded.
　　RESULTS: Cases and controls were demographically similar, with the exception of younger controls with fewer medical comorbidities. aPL profiles were similar between aPL and APS. In women with aPL, risk of APS-type complications （odds ratio 1.3; 95% CI 0.6, 2.9） and birthweight distribution （median birthweight on a customized centile was 50.8, interquartile range 26.4-68.9; P < 0.05） were similar to controls. These findings persisted even after adjustment for maternal age and medical comorbidities.
　　CONCLUSION: Women with persistent aPL on aspirin had pregnancy outcomes that were similar to controls. These data suggest that in the absence of other risk factors, women with aPL do not need intense antenatal surveillance or modified management in pregnancy.