目 的：

抗磷脂抗体阳性(APL)被认为是不良妊娠结局(APO)的危险因素。本研究的目的是研究APL阳性的患者，孤立的(APL携带者)或为原发性抗磷脂综合征(PAPs)相关的APO的危险因素。

方 法：

在三个机构中收集了2000-2014年间符合条件的共283例孕妇的临床和实验室特征。

结 果：

出生率为87.9%，APO为50例(17.7%)。多因素分析显示，与APO相关的独立变量是伴随器官特异性自身免疫性疾病的诊断和低补体水平在妊娠早期的存在。低剂量阿司匹林(LDA)治疗组与用LDA加肝素(LMWH)治疗组相比，APO发生率无统计学差异，而LDA++LMWH的使用在三重APL阳性患者中更为频繁。

根据临床病史，将患者分为四组：产科、血栓性、非标准抗磷脂综合征(临床非标准)和APL携带者。APO于血栓形成组更常见(24%)。七例妊娠或产褥期发生血栓性事件(2.4%)。

结 论：

尽管一些APL阳性患者根据目前的建议进行有效的管理，仍可观察到出现母体和胎儿并发症。在既往有血栓形成和/或存在更复杂的自身免疫表型的患者中观察到APO的风险更高。

文献来源：

Front Immunol.2018 May 7;9:864. doi: 10.3389/fimmu.2018.00864. eCollection 2018.

Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies

Objective

Antiphospholipid antibodies positivity (aPL) is considered as a risk factor for adverse pregnancy outcome (APO). The aim of this study was to determine the risk factors for APO in patients with confirmed aPL positivity, isolated (aPL carriers) or associated with a definite primary antiphospholipid syndrome (PAPS).

Methods

The clinical and laboratory features of 283 pregnancies occurring between 2000 and 2014 in 200 women were collected in three institutions.

Results

The rate of live birth was 87.9% and APO was observed in 50 cases (17.7%). Multivariate analysis showed that the independent variables related to APO were the concomitant diagnosis of an organ-specific autoimmune disease (p = 0.012, odds ratio (OR) 3.29, confidence interval (CI) 95% 1.29–8.38) and the presence of low complement levels during the first trimester (p = 0.02, OR 2.3, CI 95% 1.17–9.15). No statistical differences were found in APO occurrence among patients treated with low-dose aspirin (LDA) versus those treated with LDA plus heparin (LMWH), but LDA + LMWH was more frequently administered in patients with triple aPL positivity (p = 0.001, OR 3.21, CI 95% 1.48–7.11) and with PAPS (p < 0.001, OR 8.08, CI 95% 4.3–15.4). Based on clinical history, the patients were divided into four groups: obstetric, thrombotic, non-criteria antiphospholipid syndrome (clinical non-criteria), and aPL carriers. APOs were more frequent in the thrombotic group (24%). Seven patients had a thrombotic event during pregnancy or puerperium (2.4%).

Conclusion

Maternal and fetal complications were observed in some aPL-positive patients despite their efficient management according to the current recommendations. A higher risk of APO was observed in patients with a previous thrombosis and/or more complex autoimmune phenotype.