Antiphospholipid syndrome
Antiphospholipid syndrome
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DOI：
10.1097/01.bor.0000218943.89365.13
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发表时间：
2006-05
影响因子：
5.1
通讯作者：
D. Erkan;M. Lockshin
中科院分区：
文献类型：
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作者：
D. Erkan;M. Lockshin
综述的目的回顾最近发表的研究，可以指导医生在持续抗磷脂抗体（aPL）阳性患者的管理。最近的发现最近两项关于两种强度华法林的前瞻性随机对照试验得出结论，中度和高强度抗凝治疗对抗磷脂综合征患者首次血栓形成后具有相似的保护作用。尽管缺乏对照研究，但有实验证据表明，羟氯喹和他汀类药物可能在APL阳性患者的管理中发挥作用。在涉及注射高滴度抗磷脂综合征人血清的抗磷脂综合征小鼠模型中，补体激活在aPL介导的胎儿丢失中至关重要，肝素可防止aPL诱导的补体激活。摘要：在持续aPL阳性个体中的初级血栓预防缺乏循证方法;在高危期消除可逆血栓形成风险因素和预防至关重要。持续aPL阳性个体的二级血栓预防缺乏风险分层方法;尽管目前推荐终身华法林，但华法林的必要性、持续时间和强度仍有争议。灾难性抗磷脂综合征患者通常接受抗凝、皮质类固醇、静脉注射免疫球蛋白和血浆置换的联合治疗;显然需要测试新的药物。有妊娠病史的aPL阳性患者预防胎儿丢失的常见策略是低剂量阿司匹林和肝素;如果患者未能接受此方案，下一步是添加静脉注射免疫球蛋白，尽管这没有得到对照研究的支持。目前，没有证据表明抗凝治疗对抗磷脂抗体的非血栓性表现有效。
Purpose of reviewTo review the recently published studies that can guide physicians in the management of persistently antiphospholipid antibody (aPL)-positive patients. Recent findingsTwo recent prospective randomized controlled trials of two intensities of warfarin concluded that both moderate and high-intensity anticoagulation are similarly protective in antiphospholipid syndrome patients after the first thrombosis. Despite lack of controlled studies, there is experimental evidence that hydroxychloroquine and statins may play a role in the management of aPL-positive patients. In the mouse model of antiphospholipid syndrome that involves the injection of high-titer antiphospholipid syndrome human serum, complement activation is essential in aPL-mediated fetal loss and heparin prevents aPL-induced complement activation. SummaryPrimary thrombosis prevention in persistently aPL-positive individuals lacks an evidence-based approach; elimination of reversible thrombosis risk factors and prophylaxis during high-risk periods is crucial. Secondary thrombosis prevention in persistently aPL-positive individuals lacks a risk-stratified approach; although the current recommendation is life-long warfarin, the necessity, duration, and the intensity of warfarin are still debated. Catastrophic antiphospholipid syndrome patients usually receive a combination of anticoagulation, corticosteroids, intravenous immunoglobulin, and plasma exchange; there is a clear need to test new agents. A common strategy to prevent fetal loss in aPL-positive patients with history of pregnancy morbidities is low-dose aspirin and heparin; if patients fail this regimen, the next step is the addition of intravenous immunoglobulin although this is not supported by controlled studies. Currently, there is no evidence that anticoagulation is effective for nonthrombotic manifestations of antiphospholipid antibodies.