抗心磷脂抗体检测在孕妇不良妊娠结局中的临床意义

目的：探讨抗心磷脂抗体（anticardiolipin antibodies,ACA）与孕妇不良妊娠结局的关系,了解抗心磷脂抗体在孕妇早期反复自然流产、胎儿宫内发育迟缓、死胎等不良妊娠结局中的临床意义。方法用酶联免疫吸附实验（ELISA）方法检测120例有早期复发性流产或胎儿宫内发育迟缓、死胎的患者（称之为实验组）体内的ACA水平,并与120例正常组对照。结果120例患者组中ACA阳性46例,阳性率为38.33%,120例正常对照组中ACA阳性9例,阳性率为7.50%,两组阳性率比较,有显著性差异（P〈0.01）。结论抗心磷脂抗体水平与孕妇不良妊娠结局具有密切的相关性,因此,抗心磷脂抗体的测定对于预测妊娠结局,维持早期妊娠具有重要意义,ACA 可作为预测高危妇女早期自然流产发生的一种较为敏感的指标。     

子痫前期患者抗心磷脂抗体和抗β2糖蛋白Ⅰ水平与妊娠结局的关系

目的探讨子痫前期患者抗心磷脂抗体(ACA)、抗β2糖蛋白Ⅰ(β2-GPⅠ)水平与妊娠结局的关系。方法选择轻度子痫前期组36例、重度子痫组28例、对照组32例,检测血ACA-IgM、ACA-IgG与抗(β2-GPⅠ)水平,并记录妊娠结局。结果重度前期组患者血清ACA-IgG、ACA-IgM、抗β2-GPⅠ水平显著高于轻度子痫前期组和对照组;轻度子痫前期组患者血清ACA-IgG、ACA-IgM、抗β2-GPⅠ水平显著高于对照组。早产的子痫前期患者血清ACA-IgG、ACA-IgM、抗β2-GPⅠ水平均显著高于足月产的子痫前期患者。胎儿生长受限的子痫前期患者血清ACA-IgM显著高于对照组,ACA-IgG、ACA-IgM、抗β2糖蛋白Ⅰ两两之间均存在显著的相关性(P均0.05)。结论抗心磷脂抗体与抗β2糖蛋白Ⅰ抗体参与了子痫前期的发生发展过程。     

早发型重度子痫前期母血中抗磷脂抗体及血栓前状态变化的研究

目的：研究重度子痫前期患者母血的抗磷脂抗体及血栓前状态等标志物变化,寻找敏感、有效的指标预测早发型重度子痫前期的发生。方法收集需住院分娩的重度子痫前期的孕妇共70例,早发型重度子痫前期患者32例;晚发型重度子痫前期患者38例。同时随机选取30例同期入院的正常孕妇为对照组。所有的孕妇均为单胎妊娠,排除慢性高血压及慢性肾病。住院时检测：血常规、血脂、肾功能、肝功能、糖耐量、24 h尿蛋白定量;凝血四项、栓溶二聚体（D-Dimer）、抗凝血酶Ⅲ（AT-Ⅲ）等血栓前状态分子标志物;抗心磷脂抗体（ACA）-IgM、IgG及抗β2-GPI抗体定量等生化指标。结果早发型重度子痫前期抗磷脂抗体阳性率及ACA-IgM的滴度值明显高于晚发型重度子痫前期及正常对照组,差异有统计学意义（P＜0.05）,晚发型重度子痫前期抗磷脂抗体阳性率高于正常对照组,差异无统计学意义（P＞0.05）;早发型和晚发型重度子痫前期的血栓前状态比正常妊娠组更为严重,差异有统计学意义（P＜0.05）,但早发型和晚发型重度子痫前期的血栓前状态比较差异无统计性意义（P＞0.05）;抗磷脂抗体定量与血栓前状态的严重程度不存在明显相关性。结论对有高危因素的孕妇可通过检测血栓前状态的变化预测重度子痫前期的发病,进一步可通过抗磷脂抗体阳性率及ACA-IgM的滴度值鉴别早发型和晚发型重度子痫前期。     

子痫前期患者血清ACA、D-二聚体、IP-10、PLGF水平变化及与妊娠结局的关系

目的 研究子痫前期患者血清抗心磷脂抗体(ACA)、D-二聚体、趋化因子(IP-10)及胎盘生长因子(PIGF)水平变化及预测不良妊娠结局的价值。方法 选取2020年2月至2021年6月张家口市第一医院收治的子痫前期患者62例,分为轻度组(30例)和重度组(32例)。另外选取同期于本院分娩的正常产妇58名作为对照组。检测各组血清抗心磷脂抗体-免疫球蛋白G(ACA-IgG)、抗心磷脂抗体-免疫球蛋白M(ACA-IgM)、D-二聚体、IP-10及PIGF水平。随访至妊娠结束,并比较三组妊娠结局。分析血清ACA-IgG、ACA-IgM、D-二聚体、IP-10、PLGF水平与妊娠结局的关系。通过受试者工作特征曲线(ROC)分析血清ACA-IgG、ACA-IgM、D-二聚体、IP-10、PLGF水平预测妊娠结局的效能。结果 ACA-IgG、ACA-IgM、D-二聚体、IP-10组间比较：重度组>轻度组>对照组,差异有统计学意义(F=102.643、155.868、170.863、286.744,均P<0.05)。PLGF组间比较：重度组<轻度组<对照组,差异有统计学意...     

妊娠合并抗磷脂抗体综合征的现状及进展

正抗磷脂综抗体合征(antiphospholipid syndrome,APS)是非炎症性的一种自身免疫性病,特点为抗磷脂抗体(Antiphospholipid antibody,aPL)持续中高效价阳性,其最常见的临床表现有动脉或静脉血栓形成和/或反复的不良妊娠等,其发病机制目前尚未完全明确。因此,加强对妊娠合并APS的认识有利于更好地进行临床干预,降低血栓及孕期合并症的发生率,改善患者的妊娠结局。本篇综述主要研究妊娠合并APS的现状以及研究进展。     

妊娠高血压孕妇抗磷脂抗体水平与妊娠结局的相关性

目的探讨妊娠高血压孕妇外周血抗磷脂抗体(ACA)水平与不良妊娠结局的相关性。方法仅ACA阳性的妊娠高血压孕妇50例归入观察A组,仅抗β2-糖蛋白1(β2-GP1)抗体阳性孕妇50例归入观察B组,ACA及抗β2-GP1抗体均阴性孕妇50例归入对照组。比较3组孕妇妊娠不良结局出现率。以观察A组和观察B组孕妇为研究对象,分析ACA-Ig M、ACA-Ig G、抗β2-GP1抗体与胎儿宫内发育迟缓(FGR)、围产儿死亡、早产等主要不良妊娠结局的相关性。结果观察A组和观察B组不良妊娠结局出现率均显著高于对照组(P0.05)。ACA-Ig M与FGR呈显著正相关性(P0.05),ACA-Ig G、ACA-Ig M及抗β2-GP1抗体水平均与早产呈现正相关性(P0.05),抗β2-GP1抗体与围产儿死亡呈正相关性(P0.05)。结论妊娠高血压孕妇ACA水平与不良妊娠结局存在一定相关性。     

益肾活血解毒中药与小剂量阿司匹林治疗抗心磷脂抗体阳性复发性流产的临床分析

目的:探讨益肾活血解毒中药与小剂量阿司匹林治疗抗心磷脂抗体阳性复发性流产的临床效果。方法:将2012年12月~2013年12月我院收治的60例抗心磷脂抗体阳性复发性流产患者分为观察组与对照组各30例。对照组给予阿司匹林口服治疗,观察组则采取小剂量阿司匹林与益肾活血解毒中药联合治疗,观察两组抗心磷脂抗体阴转率及妊娠结局。结果:观察组抗体阴转率为86.7%,明显高于对照组的53.3%(P0.05)。观察组妊娠结局明显优于对照组(P0.05)。结论:益肾活血解毒中药与小剂量阿司匹林联合治疗抗心磷脂抗体阳性复发性流产效果确切,抗体清除率较高,可有效改善孕妇妊娠结局,应予以推广应用。     

S/D值在子痫前期患者妊娠结局预测中的价值

目的探讨脐血流收缩期血流峰速/舒张末期血流谷速值在子痫前期患者不良妊娠结局预测中的价值。方法598例子痫前期孕产妇(患者组)、240名健康孕产妇(对照组)均于孕28周—30周行腹部彩超检查,检测胎儿脐血流收缩期血流峰速/舒张末期血流谷速值,统计两组不良妊娠结局发生率,并比较不同妊娠结局子痫前期患者组与对照组的检测结果。采用线性回归分析及受试者工作特征曲线探讨脐血流收缩期血流峰速/舒张末期血流谷速值在子痫前期患者不良妊娠结局预测中的价值。结果患者组不良妊娠结局发生率显著高于对照组(P<0.01);不良妊娠结局患者组脐血流收缩期血流峰速/舒张末期血流谷速值>良好妊娠结局患者组>对照组,组间两两比较差异有统计学意义(P<0.01)。进行线性回归分析得到回归方程:Y=0.234+0.489X;绘制受试者工作特征曲线显示,脐血流收缩期血流峰速/舒张末期血流谷速值预测子痫前期不良妊娠结局的曲线下面积为0.902,最佳阈值取2.375时,可以得到理想的敏感度、特异度,分别为0.965、0.911。结论子痫前期患者胎儿脐血流收缩期血流峰速/舒张末期血流谷速值升高,可能预示着不良妊娠结局高风险,可将其动态监测用于子痫前期患者不良妊娠结局风险的预测。     

子宫动脉频谱形态异常可预测系统性红斑狼疮患者的妊娠结局

目的探讨子宫动脉多普勒在预测系统性红斑狼疮（SLE)合并妊娠母胎结局中的应用价值。方法回顾性选取45例系统性红斑狼疮合并妊娠孕妇,分析两组患者的临床情况及新生儿结局,并根据子宫动脉多普勒频谱是否出现切迹、搏动指数（PI)值增高,将患者分为正常组（n=31)及异常组（n=14),比较两组间的差异。结果45例孕妇中,15例（33%)出现子痫前期、狼疮性肾炎及抗磷脂综合征,胎儿出现不良结局共9例（20%)。子宫动脉频谱正常组31例（69%),5例（11%)孕妇发生子痫前期,1例（2%)胎儿发生小于胎龄儿。子宫动脉频谱异常组14例（31%),10例（22%)孕妇出现并发症,包括子痫前期、狼疮性肾炎,抗磷脂抗体（+)及抗磷脂综合征;8例（18%)胎儿发生不良结局:包括小于胎龄儿、胎儿生长受限及胎儿丢失。3例（7%)妊娠期新发SLE患者,孕妇子宫动脉波形均出现异常（波形出现切迹、PI值增高),3例胎儿均于围生期死亡。子宫动脉波形异常组母体并发症及胎儿不良结局的发生率均高于波形正常组,组间差异有统计学意义（P < 0.01)。结论孕妇子宫动脉频谱形态异常是预测妊娠期SLE加重及胎儿发生不良结局的敏感指标。      

早发型重度子痫前期胎儿不良围产结局及其影响因素分析

目的探讨早发型重度子痫前期胎儿不良围产结局及其危险因素。方法对89例单胎妊娠、接受期待治疗的早发型(发病孕龄24～34周)重度子痫前期患者的住院病例进行回顾性分析。结果不同发病孕龄的产妇其胎儿不良结局的发生率比较差异具有统计学意义(P<0.01);发病孕龄和入住房间床位数是胎儿围产结局的影响因素。结论入住房间床位数是胎儿发生不良围产结局的危险因素,发病孕龄是胎儿发生不良围产结局的重要保护因素,医务工作者应积极努力查找早发型重度子痫前期的发病原因,做好孕期保健,预防疾病的发生。     

Autoimmune disease as a cause of reproductive failure

High-risk pregnancy is the most common clinical association with antiphospholipid antibodies; the principal manifestations are pregnancy loss and early preeclampsia. Membership in this family of antibodies is continually growing and includes antibodies against a variety of phospholipids, phospholipid-protein complexes, and phospholipid-binding proteins. The current information in the literature is inadequate to clearly implicate a subgroup of antiphospholipid antibodies or a particular pathophysiologic mechanism as being responsible for poor pregnancy outcomes. It is clear, however, that prevalent diagnostic tests for LA and aCL are extremely useful to identify many of these patients, but are inadequate for diagnosis of all patients with autoimmune pregnancy loss or to elucidate the pathophysiology. Many patients who present clinically with autoimmune-like pregnancy complications currently are negative in tests for LA or aCL, but have antibodies against annexin V, phosphatidylserine, or other relevant antigens. The greatest risk for a complicated pregnancy is conveyed by a subgroup of antibodies that affect the normal function of placental trophoblast. As clinical laboratory tests designed to detect more members of the antiphospholipid antibody family become available, understanding of this complicated disease (APS) will increase.     

抗磷脂综合征发病机制及诊治进展

抗磷脂综合征(antiphospholipid syndrome,APS)主要表现为血栓形成或病态妊娠,实验室检测抗磷脂抗体(an-tiphospholipid antibody,APL)阳性,如抗心磷脂抗体(anticardiolipin antibody,ACA)、抗β2-糖蛋白1(β2-glycoprotein l,β2-GP1)抗体及狼疮抗凝物(lupus anticoagulant,LAC)。β2-GP1及其抗体在APS发病机理中的作用日益受到人们的重视。APS累及全身多个系统,治疗上除肝素、华法林和阿司匹林外,还可试用免疫抑制剂、大剂量丙种球蛋白等,其他与发病机制相关的免疫治疗仍在进一步研究中。     

Pregnancy complicated by antiphospholipid antibodies

The manifestations of antiphospholipid antibodies in pregnancy are multiple and include maternal arterial and venous thrombosis, spontaneous abortion, intrauterine fetal death, intrauterine growth retardation, and preeclampsia. Maternal complications may also arise in the puerperium with the development of an autoimmune pleuropulmonary postpartum syndrome. Currently, there is confusion in the literature regarding appropriate treatment of patients known to possess these antibodies. We have reported the case of a patient at 29 weeks' gestation who had elevated blood pressure, proteinuria, and early intrauterine growth retardation. Studies were positive for the presence of both lupus anticoagulant and anticardiolipin antibodies. After delivery, chest pain and a pleural effusion developed as further manifestations of the patient's autoimmune disease.     

Antiphospholipid, anti-beta 2-glycoprotein-I and anti-oxidized-low-density-lipoprotein antibodies in antiphospholipid syndrome

Antiphospholipid antibodies (aPL), anti-beta 2-glycoprotein I (anti-beta 2-GPI) and anti-oxidized-low-density lipoprotein (LDL) antibodies are all implicated in the pathogenesis of antiphospholipid syndrome. To investigate whether different autoantibodies or combinations thereof produced distinct effects related to their antigenic specificities, we examined the frequencies of antiphospholipid syndrome (APS)-related features in the presence of different antibodies [aPL, beta 2-GPI, anti-oxidized low density lipoprotein (LDL)] in 125 patients with APS. Median follow-up was 72 months: 58 patients were diagnosed as primary APS and 67 as APS plus systemic lupus erythematosus (SLE). Anticardiolipin antibodies (aCL), anti-beta 2-GPI and anti-oxidized LDL antibodies were determined by ELISA; lupus anticoagulant (LA) by standard coagulometric methods. Univariate analysis showed that patients positive for anti-beta 2-GPI had a higher risk of recurrent thrombotic events (OR = 3.64, 95% CI, p = 0.01) and pregnancy loss (OR = 2.99, 95% CI, p = 0.004). Patients positive for anti-oxidized LDL antibodies had a 2.24-fold increase in the risk of arterial thrombosis (2.24, 95% CI, p = 0.03) and lower risk of thrombocytopenia (OR = 0.41 95% CI, p = 0.04). Patients positive for aCL antibodies had a higher risk of pregnancy loss (OR = 4.62 95% CI, p = 0.001). When these data were tested by multivariate logistic regression, the association between anti-beta 2-GPI and pregnancy loss and the negative association between anti-oxidized LDL antibodies and thrombocytopenia disappeared.     

Impaired uterine arterial blood flow in pregnant women with recurrent pregnancy loss.

OBJECTIVE: This study was undertaken to evaluate uterine perfusion, which regulates uterine receptivity, in women with recurrent pregnancy loss. METHODS: We evaluated the blood flow resistance in the uterine arteries of 104 pregnant women at 4 to 5 weeks' gestation by transvaginal pulsed Doppler ultrasonography (control group, n = 52; and recurrent pregnancy loss group, n = 52). Blood tests for antinuclear and antiphospholipid antibodies were also performed. RESULTS: The uterine arterial pulsatility index in the recurrent pregnancy loss group was significantly higher than that in the control group. Women with antinuclear or antiphospholipid antibodies had an elevated pulsatility index in the uterine artery, which is prominent in women with recurrent pregnancy loss. Coagulopathy and vascular dysfunction caused by autoantibodies may impair uterine perfusion. However, the uterine arterial pulsatility index in the recurrent pregnancy loss group was significantly higher than that in the control group even among women without antinuclear antibodies or among women without antiphospholipid antibodies. This observation strongly suggests that the uterine artery pulsatility index may be an independent index for recurrent pregnancy loss. CONCLUSIONS: The introduction of pulsed Doppler ultrasonography has provided the means for noninvasive evaluation of uterine impedance and may identify patients with recurrent pregnancy loss associated with impaired uterine perfusion.     

Migraine and antiphospholipid antibodies

Antiphospholipid antibodies have been detected in patients with transient neurologic symptoms including migraine aura. The role of these antibodies in the pathogenesis of migraine is not fully understood. The available data suggest an association between the migraine-like phenomena and antiphospholipid antibodies, but not between migraine headache and antiphospholipid antibodies. To elucidate the actual role of antiphospholipid antibodies in migraine, prospective, controlled studies are needed.     

Thrombophilia and principle of thrombosis prevention in obstetrics

One of the major causes of maternity death are complications of venous thromboembolism (VT). Risk of their occurrence during pregnancy is 5 to 10 times higher comparing to non-pregnant women. Hereditary trombophilia and antiphospholipid syndrome increase the risk of complications of venous thromboembolism significantly. In addition to VT, trombophilia is associated with miscarriage, placental abruption and severe preeclampsia. The aggravating factor is the presence of certain limitations in administration of some medications for thrombosis prophylaxis during pregnancy. Issues of medical care in pregnant patients with thrombophilia, artificial heart valves or acute VT complications are highlighted in the article, as well as principles of thrombosis prophylaxis during cesarean section or in women with VT in anamnesis. Evidence based recommendations of the recent American College of Chest Physicians consensus conference are presented for each issue.