Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus.
Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus.
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心磷脂抗体可作为系统性红斑狼疮妊娠患者胎儿窘迫或死亡的预测因子。
DOI：
10.1056/nejm198507183130304
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Ferenc,M
中科院分区：
文献类型：
--
作者：
Lockshin,MD;Druzin,ML;Goei,S;Qamar,T;Magid,MS;Jovanovic,L;Ferenc,M
在一项对系统性红斑狼疮妇女妊娠的前瞻性研究中，我们检测了心磷脂抗体（通过酶联免疫吸附试验测量）与妊娠中期胎儿窘迫（通过产前胎儿心率测试异常结果或胎儿死亡确定）之间的关系。所有9例狼疮患者及其并发症均有异常高的抗体水平（平均212.3±55.3单位），而正常非妊娠妇女的抗体水平为28.2±10.1单位。12例无此并发症的狼疮孕妇抗体水平均不高于50个单位（平均27.5±3.4个单位，与狼疮合并胎儿窘迫的妇女相比P<0.005）；12例未患狼疮的孕妇中有4例抗体水平高于50单位（平均42.5±11.0），抗体水平最高者发生胎儿死亡。12例非妊娠狼疮患者的平均抗体水平为117.4±35.0单位。2例有狼疮抗凝剂但非临床狼疮的患者，均有胎儿死亡史，抗体水平也较高；一例发生胎儿死亡，另一例发生自发性胎儿心动过缓。心磷脂抗体与狼疮抗凝剂或血小板减少症的病史有松散的联系，但与此同时不存在明显的狼疮抗凝剂或血小板减少症，并且可以在妊娠早期作为抗凝剂或血小板减少症检测到。我们得出结论，心磷脂抗体的测定是预测系统性红斑狼疮患者胎儿窘迫或死亡最敏感的测定方法，并且可能在该综合征的发病机制中具有重要意义。[J] .中华医学杂志，1985;31(3):152 - 6。
During a prospective study of pregnancies in women with systemic lupus erythematosus, we examined the relation between antibody to cardiolipin, measured by the enzyme-linked immunosorbent assay, and midpregnancy fetal distress, identified by abnormal results of antepartum fetal heart-rate testing or by fetal death. All of nine patients with lupus and this complication had abnormally high antibody levels (mean, 212.3±55.3 units), as compared with values in normal nonpregnant women (28.2±10.1 units). None of 12 pregnant patients with lupus but without this complication had antibody levels above 50 units (mean, 27.5±3.4 units; P<0.005 vs. women with lupus and fetal distress); 4 of 12 pregnant subjects without lupus had antibody levels above 50 units (mean, 42.5±11.0), and fetal death occurred in the subject with the highest level. The mean antibody level in 12 nonpregnant patients with lupus was 117.4±35.0 units. Two patients who had lupus anticoagulant but not clinical lupus, both with histories of prior fetal death, also had high antibody levels; fetal death occurred in one, and spontaneous fetal bradycardia in the other. Antibody to cardiolipin was loosely linked to a history, but not the simultaneous presence, of demonstrable lupus anticoagulant or thrombocytopenia, and could be detected as early in pregnancy as either anticoagulant or thrombocytopenia. We conclude that measurement of antibody to cardiolipin is the most sensitive assay to predict fetal distress or death in patients with systemic lupus erythematosus and may be of pathogenetic importance in this syndrome. (N Engl J Med 1985; 313:152–6.)
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