Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study
Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study
复制标题
DOI：
10.1055/s-0038-1632388
复制
发表时间：
2018-04-01
影响因子：
6.7
通讯作者：
Khamashta, Munther A.
中科院分区：
文献类型：
--
作者：
Ruffatti, Amelia;Tonello, Marta;Khamashta, Munther A.
在高危原发性抗磷脂综合征（PAPS）患者中检查了额外治疗联合常规治疗对妊娠结局的影响，以确定最有效的治疗策略。该研究的入选标准为（1）单独或与抗心磷脂和/或抗2-糖蛋白I抗体相关的狼疮抗凝剂阳性;（2）重度母胎并发症史（I组）或一次或多次常规治疗难治性妊娠史，导致与重度母胎并发症无关的不明原因胎儿死亡（II组）。考虑了两种不同的额外治疗：或小剂量类固醇（每日10- 20 mg泼尼松）和/或每日200 - 400 mg剂量的羟氯喹和胃肠外静脉注射免疫球蛋白（2 g/kg/月）和/或血浆置换。该研究的主要结果是活产率和妊娠并发症。回顾性入组了在20个三级中心就诊的194例妊娠PAPS患者。在第II组患者中，发现羟氯喹与其他口服治疗相比活产率显著更高相关。高剂量（400 mg）与低剂量（200 mg）羟氯喹（p =0.036）以及妊娠前与妊娠期间给药（p =0.021）与活产率显著较高相关。羟氯喹治疗对既往无血栓形成的PAPS患者特别有效。肠外治疗与活产率显著高于口服治疗（p =0.037）相关，尤其是在第I组患者中。总之，一些额外的治疗被认为是安全和有效的高风险PAPS孕妇。
The effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The study's inclusion criteria were (1) positivity to lupus anticoagulant alone or associated with anticardiolipin and/or anti-2 glycoprotein I antibodies; (2) a history of severe maternal-foetal complications (Group I) or a history of one or more pregnancies refractory to conventional therapy leading to unexplained foetal deaths not associated with severe maternal-foetal complications (Group II). Two different additional treatments were considered: orallow-dose steroids (10-20mg prednisone daily) and/or 200 to 400mg daily doses of hydroxychloroquine and parenteralintravenous immunoglobulins at 2 g/kg per month and/or plasma exchange. The study's primary outcomes were live birth rates and pregnancy complications. A total of 194 pregnant PAPS patients attending 20 tertiary centres were retrospectively enrolled. Hydroxychloroquine was found to be linked to a significantly higher live birth rate with respect to the other oral treatments in the Group II patients. The high (400 mg) versus low (200 mg) doses of hydroxychloroquine ( p =0.036) and its administration before versus during pregnancy ( p =0.021) were associated with a significantly higher live birth rate. Hydroxychloroquine therapy appeared particularly efficacious in the PAPS patients without previous thrombosis. Parenteral treatments were associated with a significantly higher live birth rate with respect to the oral ones ( p =0.037), particularly in the Group I patients. In conclusion, some additional treatments were found to be safe and efficacious in high-risk PAPS pregnant women.