切换至 "中华医学电子期刊资源库"

中华产科急救电子杂志 ›› 2019, Vol. 08 ›› Issue (02) : 87 -92. doi: 10.3877/cma.j.issn.2095-3259.2019.02.006

所属专题: 文献

专家论坛

产科抗磷脂综合征的诊断和治疗
刘平1, 樊尚荣1,()   
  1. 1. 518036 深圳,北京大学深圳医院妇产科
  • 收稿日期:2019-01-28 出版日期:2019-05-18
  • 通信作者: 樊尚荣
  • 基金资助:
    深圳市科创委基础研究项目(JCYJ20160428175005906)

Diagnosis and management of obstetric antiphospholipid syndrome

Ping Liu1, Shangrong Fan1()   

  • Received:2019-01-28 Published:2019-05-18
  • Corresponding author: Shangrong Fan
引用本文:

刘平, 樊尚荣. 产科抗磷脂综合征的诊断和治疗[J]. 中华产科急救电子杂志, 2019, 08(02): 87-92.

Ping Liu, Shangrong Fan. Diagnosis and management of obstetric antiphospholipid syndrome[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(02): 87-92.

产科抗磷脂综合征可导致早期复发性流产、死胎、胎盘功能不全和子痫前期等。小剂量阿司匹林和低分子量肝素为一线治疗方案,但仍有30%的病例治疗失败。难治性产科抗磷脂综合征、灾难性抗磷脂综合征的治疗可以使用羟基氯喹、糖皮质激素、静脉免疫球蛋白和血浆置换。抗磷脂综合征妊娠已成为产科研究的一个重要领域,新的治疗方法不断出现。

Obstetric antiphospholipid syndrome can lead to early recurrent miscarriage, stillbirth, placental insufficiency and preeclampsia. Low-dose aspirin and low-molecular-weight heparin are first-line treatment options, but 30% of cases still fail. Refractory obstetric antiphospholipid syndrome, catastrophic antiphospholipid syndrome patients can be treated with hydroxychloroquine, glucocorticoid, intravenous immunoglobulin and plasma exchange. Pregnancy with antiphospholipid syndrome has become an important area of obstetric research, and new treatments are emerging.

图1 产科APS疾病谱和影响
图2 产科APS的发病机制模式图[12]。(1)抗磷脂抗体与β2糖蛋白Ⅰ直接作用引起凝血;(2)抗磷脂抗体与磷脂结合蛋白激活血小板凝血;(3)抗磷脂抗体通过白细胞和单核细胞引起细胞因子释放促进凝血;(4)抗磷脂抗体与β2糖蛋白Ⅰ结合降低抗凝因子作用;(5)第二次打击,补体激活,引起炎症反应,促进凝血;(6)抗磷脂抗体引起胎盘血管重铸障碍;(7)胎盘浅着床和组织缺氧引起胎盘源性疾病
表1 妊娠合并血栓性微血管病变的鉴别诊断[18]
[1]
中华医学会风湿病学分会.抗磷脂综合征诊断和治疗指南 [J]. 中华风湿病学杂志,2011, 15(6): 407-410.
[2]
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS) [J]. J Thromb Haemost, 2006, 4(2): 295-306.
[3]
David G, Doruk E. Diagnosis and management of the antiphospholipid syndrome [J]. N Engl J Med, 2018, 378(21): 2010-2021.
[4]
Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification for definite antiphospholipid syndrome [J]. Arthritis Rheum, 1999, 42(7): 1309-1311.
[5]
Bertolaccini ML, Amengual O, Atsumi T, et al. 'Non-criteria’ aPL tests: report of a task force and preconference workshop at the 13th International Congress on Antiphospholipid Antibodies, Galveston, TX, USA, April 2010 [J]. Lupus, 2011, 20(2): 191-205.
[6]
Sciascia S, Amigo MC, Roccatello D, et al. Diagnosing antiphospholipid syndrome: 'extra-criteria’ manifestations and technical advances [J]. Nat Rev Rheumatol, 2017, 13(9): 548-560.
[7]
de Jesus GR, Agmon-Levin N, Andrade CA, et al. 14th International Congress on Antiphospholipid Antibodies Task Force report on obstetric antiphospholipid syndrome [J]. Autoimmun Rev, 2014, 13(8): 795-813.
[8]
Arachchillage DR, Machin SJ, Mackie IJ, et al. Diagnosis and management of non-criteria obstetric antiphospholipid syndrome [J]. Thromb Haemost, 2015, 113(1): 13-19.
[9]
Drozidnsky G, Hadar E, Shmueli A, et al. Obstetric antiphospholipid syndrome and long term arterial thrombosis risk [J]. J Thromb Thrombolysis, 2017, 44(3): 371-375.
[10]
Saccone G, Berghella V, Maruotti GM, et al. Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome, the PREGNANTS study [J]. Am J Obstet Gynecol, 2017, 216(5): 525.e1-525.e12.
[11]
Abrahams VM, Chamley LW, Salmon JE. Emerging treatment models in rheumatology: antiphospholipid syndrome and pregnancy: pathogenesis to translation [J]. Arthritis Rheumatol, 2017, 69(9): 1710-1721.
[12]
Meroni P L, Crotti C, Chighizola C. Antiphospholipid antibody mechanisms of thrombosis [M]. Milan: Springer, 2015: 25-36.
[13]
Jeanette R, Carpenterand D, Ware Branch. Antiphospholipid syndrome in pregnancy [M]. In Gabbe SG, Niebyl JR, Simpson JL, et al eds. Obstetrics: Normal and Problem Pregnancies, Seventh ed. Philadelphia: Elsevier, 2017: 981-997.
[14]
Schreiber K, Sciascia S, de Groot PG, et al. Antiphospholipid syndrome [J]. Nat Rev Dis Primers, 2018, 4:17103.
[15]
Mekinian A, Alijotas-Reig J, Carrat F, et al. Refractory obstetrical antiphospholipid syndrome: Features, treatment and outcome in a European multicentre retrospective stud [J]. Autoimmun Rev, 2017, 16(7):730-734.
[16]
Jara LJ, Medina G, Cruzcruz P, et al. Non-criteria or seronegative obstetric antiphospholipid syndrome? [J]. Isr Med Assoc J, 2017, 19(6): 382-386.
[17]
吴淑燕,张建平. 复发性流产的抗凝治疗 [J]. 中国实用妇科与产科杂志,2017, 33(7):671-675.
[18]
Silver RM. Catastrophic antiphospholipid syndrome and pregnancy [J]. Semin Perinatol, 2018, 42(1): 26-32.
[19]
Schreiber K, Radin M, Sciascia S. Current insights in obstetric antiphospholipid syndrome [J]. Curr Opin Obstet Gynecol, 2017, 29(6): 397-403.
[20]
Andreoli L, Bertsias GK, Agmon-Levin N, et al. Extended report: EULAR recommendations for women′s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome [J]. Ann Rheum Dis, 2017, 76(3): 476-485.
[21]
Bala MM, Celinska-Lowenhoff M, Szot W, et al. Antiplatelet and anticoagulant agents for secondary prevention of stroke and otherthromboembolic events in people with antiphospholipid syndrome [J]. Cochrane Database Syst Rev, 2017, 10: CD012169.
[22]
Lefkou E, Mamopoulos A, Dagklis T, et al. Pravastatin improves pregnancy outcomes in obstetric antiphospholipid syndrome refractory to antithrombotic therapy [J]. J Clin Invest, 2016, 126(8): 2933-2940.
[23]
Corban MT, Duarte-Garcia A, McBane RD, et al. Antiphospholipid syndrome: role of vascular endothelial cells and implications for risk stratification and targeted therapeutics [J]. J Am Coll Cardiol, 2017, 69(18): 2317-2330.
[24]
Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome [J]. N Engl J Med, 2018, 379(13):1290.
[25]
Mekinian A, Costedoat-Chalumeau N, Masseau A, et al. Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome? [J] Autoimmun Rev, 2015, 14(1): 23-29.
[26]
Cervera R, Rodríguez-Pintó I, Espinosa G. The diagnosis and clinical management of the catastrophic antiphospholipid syndrome: a comprehensive review [J]. J Autoimmun, 2018, 92: 1-11.
[27]
Groom KM, David AL. The role of aspirin, heparin, and other interventions in the prevention and treatment of fetal growth restriction [J]. Am J Obstet Gynecol, 2018, 218(2S): S829-S840.
[28]
Ruffatti A, Hoxha A, Favaro M, et al. Additional treatments for high-risk obstetric antiphospholipid syndrome: a comprehensive review [J]. Clin Rev Allergy Immunol, 2017, 53(1): 28-39.
[29]
Cavazzana I, Andreoli L, Limper M, et al. Update on antiphospholipid syndrome: Ten Topics in 2017 [J]. Curr Rheumatol Rep, 2018, 20(3): 15.
[30]
赵爱民,低分子肝素防治自然流产中国专家共识编写组. 低分子肝素防治自然流产中国专家共识 [J]. 中华生殖与避孕杂志,2018, 38(9): 701-708.
[31]
Ye SL, Gu XK, Tao LY, et al. Efficacy of different treatment regimens for antiphospholipid syndrome-related recurrent spontaneous abortion [J]. Chin Med J (Engl), 2017, 130(12): 1395-1399.
[1] 薛静, 孙雅楠, 朱丽丽, 李淑红. 妊娠期急性脂肪肝孕产妇诊疗及其妊娠结局[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 312-321.
[2] 陈义思, 梁敏, 李红雨, 夏雪, 刘燕茜, 李晨曲, 王丹. 妊娠合并慢性肾病围产期多学科团队管理价值研究[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 133-139.
[3] 杨皓媛, 龚杰, 邹青伟, 阮航. 哮喘孕妇的母婴不良妊娠结局研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 522-529.
[4] 高坎坎, 钟华敏, 谢永强, 邓秋连, 高飞, 王洁琳, 龙燕. 女性泌尿生殖道支原体感染及其耐药率分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(05): 569-576.
[5] 龚静, 张军. 晚孕期严重心脏病孕妇剖宫产术分娩同期心脏手术的可行性[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(01): 47-52.
[6] 张燕, 粟闵, 陈婷婷, 程会贤, 陈名园, 王巍. 合体细胞滋养层细胞外囊泡阻止母体恶性肿瘤侵袭及转移至胎儿相关机制研究[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(01): 40-46.
[7] 王思, 胡青, 廖华, 王晓东, 余海燕. 先天性生殖器官异常孕妇的围生结局分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(01): 87-93.
[8] 李周平, 薛晓艳, 徐庆杰, 杜扬帆. 真性红细胞增多症并肠梗阻、抗磷脂综合征一例[J]. 中华重症医学电子杂志, 2022, 08(02): 180-186.
[9] 黄怡文, 宋青. 妊娠期高血糖诊治进展[J]. 中华产科急救电子杂志, 2023, 12(04): 217-222.
[10] 杨泽俊, 赵茵. 妊娠期易栓症的自身抗体检测[J]. 中华产科急救电子杂志, 2023, 12(02): 76-80.
[11] 陈真, 漆洪波. 易栓症与胎儿生长受限[J]. 中华产科急救电子杂志, 2023, 12(01): 18-21.
[12] 赫英东, 陈倩. 围产期易栓症的抗凝治疗[J]. 中华产科急救电子杂志, 2023, 12(01): 22-27.
[13] 郎虓, 程蔚蔚. 妊娠期铁缺乏与贫血[J]. 中华产科急救电子杂志, 2022, 11(04): 202-207.
[14] 王晓娜, 白桂芹. 体外膜肺氧合技术在重症孕产妇救治中的应用[J]. 中华产科急救电子杂志, 2022, 11(02): 81-87.
[15] 祝彩霞, 王子莲. 妊娠合并心律失常:心室率异常[J]. 中华产科急救电子杂志, 2022, 11(01): 8-12.
阅读次数
全文


摘要