Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity
Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity
复制标题
DOI：
10.1160/th14-03-0191
复制
发表时间：
2014-10-01
影响因子：
6.7
通讯作者：
Meroni, Pier Luigi
中科院分区：
文献类型：
--
作者：
Ruffatti, Amelia;Salvan, Elisa;Meroni, Pier Luigi
最近发现，在抗磷脂综合征(APS)的常规治疗中，既往血栓形成、系统性红斑狼疮(SLE)诊断和三重抗磷脂(APL)抗体阳性是导致妊娠失败的独立因素。本研究旨在评估不同治疗策略对APS妇女妊娠结局的影响以及妊娠失败的危险因素。对诊断为黄斑狼疮的196例妊娠进行了分析，其中118例(60.2%)有血栓史，81例(41.3%)诊断为系统性红斑狼疮，107例(54.6%)有三重APL阳性。175例(89.3%)接受常规治疗(小剂量阿司匹林)或预防性剂量肝素+乳酸脱氢酶或治疗量肝素+乳酸脱氢酶，21例(10.7%)在常规治疗基础上加用其他治疗方法。根据患者的危险因素血栓形成、系统性红斑狼疮和三重APL阳性及其单一、双重或三重组合，妊娠被分为七种风险特征。仅在血栓形成+三重APL阳性亚组中，才有可能发现与治疗相关的显著结局差异，Logistic回归分析表明，附加治疗是唯一与有利妊娠结局相关的独立因素(优势比=9.7，95%可信区间=1.1-88.9，p值
Previous thrombosis, diagnosis of systemic lupus erythematosus (SLE) and triple antiphospholipid (aPL) antibody positivity have recently been found to be independent factors associated to pregnancy failure during conventional therapy in women with antiphospholipid syndrome (APS). This study aimed to assess the effect of various treatment strategies on pregnancy outcomes in women with APS and the risk factors for pregnancy failure. One hundred ninety-six pregnancies of 156 patients diagnosed with APS were analysed: 118 (60.2%) of these had previous thrombosis, 81(41.3%) were diagnosed with SLE, and 107 (54.6%) had triple aPL positivity. One hundred seventy-five (89.3%) were treated with conventional therapies (low-dose aspirin ILDA] or prophylactic doses of heparin + LDA or therapeutic doses of heparin + LDA), while 21 (10.7%) were prescribed other treatments in addition to conventional therapy. The pregnancies were classified into seven risk profiles depending on the patients' risk factors thrombosis, SLE, and triple aPL positivity and their single, double or triple combinations. It was possible to find significant difference in outcomes correlated to treatments only in the thrombosis plus triple aPL positivity subset, and logistic regression analysis showed that additional treatments were the only independent factor associated to a favourable pregnancy outcome (odds ratio=9.7, 95% confidence interval=1.1-88.9, p-value