摘要:目的：低分子肝素+阿司匹林的治疗对于20%的产科抗磷脂综合征患者无效。他汀有保护内皮的功能，在动物模型中有助于改善妊娠预后。本研究将观察普伐他汀对于低分子肝素+阿司匹林无效的产科抗磷脂综合征患者预后的影响。

        方法：纳入21例在阿司匹林+低分子肝素治疗期间发生先兆子痫或者宫内发育迟缓的抗磷脂综合征患者。10例患者继续应用上述治疗，另外11例患者在发生先兆子痫或宫内发育迟缓时加用普伐他汀20m/天治疗。比较两组患者子宫胎盘血流动力学、高血压、蛋白尿的变化以及胎儿的结局。

        结果：对照组中，所有患者均早产，其中6例患者新生儿存活。存活的新生儿中3例发育异常。加用普伐他汀组患者胎盘血流和先兆子痫的表现均有改善。这些改善在加用普伐他汀10天后即可观察到。加用普伐他汀组患者均为足月活产。

        结论：本研究显示，在先兆子痫或者宫内发育迟缓发生时即加用普伐他汀有助于改善难治性产科抗磷脂综合征患者的预后。

        附原文：

        BACKGROUND: Administration of conventionalantithrombotic treatment (low-dose aspirin plus low-molecular weight heparin[LDA+LMWH]) for obstetric antiphospholipid syndrome (APS) does not preventlife-threatening placenta insufficiency-associated complications such aspreeclampsia (PE) and intrauterine growth restriction (IUGR) in 20% ofpatients. Statins have been linked to improved pregnancy outcomes in mousemodels of PE and APS, possibly due to their protective effects on endothelium.Here, we investigated the use of pravastatin in LDA+LMWH-refractory APS inpatients at an increased risk of adverse pregnancy outcomes.METHODS: We studied21 pregnant women with APS who developed PE and/or IUGR during treatment withLDA+LMWH. A control group of 10 patients received only LDA+LMWH. Elevenpatients received pravastatin (20 mg/d) in addition to LDA+LMWH at the onset ofPE and/or IUGR. Uteroplacental blood hemodynamics, progression of PE features(hypertension and proteinuria), and fetal/neonatal outcomes wereevaluated.RESULTS: In the control group, all deliveries occurred preterm andonly 6 of 11 neonates survived. Of the 6 surviving neonates, 3 showed abnormaldevelopment. Patients who received both pravastatin and LDA+LMWH exhibitedincreased placental blood flow and improvements in PE features. Thesebeneficial effects were observed as early as 10 days after pravastatintreatment onset. Pravastatin treatmentcombined with LDA+LMWH was alsoassociated with live births that occurred close to full term in allpatients.CONCLUSION: The present study suggests that pravastatin may improvepregnancy outcomes in women with refractory obstetric APS when taken at theonset of PE or IUGR until the end of pregnancy.

        引自：Lefkou E,Mamopoulos A,Dagklis T，et al. Pravastatin improves pregnancy outcomes in obstetric antiphospholipidsyndrome refractory to antithrombotic therapy.J Clin Invest.2016 Aug 1;126 (8):2933-40.