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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

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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]
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