Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies.
Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies.
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DOI：
10.1002/art.34402
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发表时间：
2012-07
影响因子：
--
通讯作者：
Salmon, Jane E.
中科院分区：
文献类型：
--
作者：
Lockshin, Michael D.;Kim, Mimi;Laskin, Carl A.;Guerra, Marta;Branch, D. Ware;Merrill, Joan;Petri, Michelle;Porter, T. Flint;Sammaritano, Lisa;Stephenson, Mary D.;Buyon, Jill;Salmon, Jane E.
抗磷脂抗体（aPL）患者的血清学和临床表现预测不良妊娠结局（APO）是有争议的。PROMISSE是一项针对aPL患者中APO风险因素（狼疮抗凝剂[LAC]、抗心磷脂抗体[aCL]和/或β2糖蛋白I抗体[抗β2-GP-I]）的多中心、前瞻性观察性研究。我们检验了一种假设，即临床和血清学变量的模式可以识别出APO风险最高的女性。在2003年至2011年期间，我们招募了144名妊娠患者，其中28名患有APO。39%的LAC患者患有APO，而没有LAC的患者为3%（p < 0.0001）。IgG aCL ≥40 u/mL但非LAC的女性中，只有8%患有APO，而LAC患者中为43%（p = 0.002）。IgM aCL或IgG或IgM抗-β2-GP-I不能预测APO。在双变量分析中，APO发生在52%有血栓形成的患者和13%无血栓形成的患者中（p = 0.00005），23%有SLE，17%无SLE（不显著）; SLE是多变量分析的预测因子。既往妊娠丢失不能预测载脂蛋白O，母亲种族也不能预测载脂蛋白O。联合应用aCL、抗β2-GP-I和LAC并不比单独应用LAC更好地预测APO。在APL相关妊娠中，LAC是妊娠12周后APO的主要预测因素。如果不同时存在LAC，ACL和抗β2-GP-I不能预测APO。
Which serologic and clinical findings predict adverse pregnancy outcome (APO) in patients with antiphospholipid antibody (aPL) is controversial. PROMISSE is a multicenter, prospective observational study of risk factors for APO in patients with aPL (lupus anticoagulant [LAC], anticardiolipin antibody [aCL] and/or antibody to β2 glycoprotein I [anti-β2-GP-I]). We tested the hypothesis that a pattern of clinical and serological variables can identify women at highest risk for APO. Between 2003 and 2011 we enrolled 144 pregnant patients, of whom 28 had APO. Thirty-nine percent of patients with LAC had APO, compared to 3% who did not have LAC (p < 0.0001). Only 8% of women with IgG aCL ≥40 u/mL but not LAC suffered APO, compared to 43% of those with LAC (p = 0.002). IgM aCL or IgG or IgM anti-β2-GP-I did not predict APO. In bivariate analysis, APO occurred in 52% of patients with and 13% of patients without prior thrombosis (p = 0.00005), and in 23% with SLE compared to 17% without SLE (not significant); SLE was a predictor in multivariate analysis. Prior pregnancy loss did not predict APO, nor did maternal race. Simultaneous aCL, anti-β2-GP-I, and LAC did not predict APO better than did LAC alone. LAC is the primary predictor of APO after 12 weeks gestation in aPL-associated pregnancies. ACL and anti-β2-GP-I, if LAC is not also present, do not predict APO.
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影响因子：
6.7
作者：
Ruffatti, Amelia;Tonello, Marta;Pengo, Vittorio
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Pengo, Vittorio
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de Grootb, Ph. G.
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