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首页> 外文期刊>Thrombosis and Haemostasis: Journal of the International Society on Thrombosis and Haemostasis >Diagnosis and management of non-criteria obstetric antiphospholipid syndrome
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Diagnosis and management of non-criteria obstetric antiphospholipid syndrome

机译：非标准产科抗磷脂综合征的诊断和治疗

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摘要

Accurate diagnosis of obstetric antiphospholipid syndrome (APS) is a prerequisite for optimal clinical management. The international consensus (revised Sapporo) criteria for obstetric APS do not include low positive anticardiolipin (aCL) and anti beta(2) glycoprotein I (a beta(2)GPI) antibodies (<99th centile) and/or certain clinical criteria such as two unexplained miscarriages, three non-consecutive miscarriages, late pre-eclampsia, placental abruption, late premature birth, or two or more unexplained in vitro fertilisation failures. In this review we examine the available evidence to address the question of whether patients who exhibit non-criteria clinical and/or laboratory manifestations should be included within the spectrum of obstetric APS. Prospective and retrospective cohort studies of women with pregnancy morbidity, particularly recurrent pregnancy loss, suggest that elimination of aCL and/or IgM a beta 2GPI, or low positive positive aCL or a beta 2GPI from APS laboratory diagnostic criteria may result in missing the diagnosis in a sizeable number of women who could be regarded to have obstetric APS. Such prospective and retrospective studies also suggest that women with non-criteria obstetric APS may benefit from standard treatment for obstetric APS with low-molecular-weight heparin plus low-dose aspirin, with good pregnancy outcomes. Thus, non-criteria manifestations of obstetric APS may be clinically relevant, and merit investigation of therapeutic approaches. Women with obstetric APS appear to be at a higher risk than other women of pre-eclampsia, placenta-mediated complications and neonatal mortality, and also at increased long-term risk of thrombotic events. The applicability of these observations to outcomes in women with non-criteria obstetric APS remains to be determined.
机译：准确诊断产科抗磷脂综合征（APS）是最佳临床管理的先决条件。产科APS的国际共识（修订后的札幌）标准不包括低阳性抗心磷脂（aCL）和抗β（2）糖蛋白I（β（2）GPI）抗体（<99％）和/或某些临床标准，例如两次不明原因的流产，三例非连续性流产，先兆子痫，胎盘早剥，早产或两次或多次不明原因的体外受精失败。在这篇综述中，我们检查了可利用的证据，以解决那些表现出非标准临床和/或实验室表现的患者是否应包括在产科APS频谱中的问题。对有妊娠合并症，特别是反复妊娠流产的妇女进行的前瞻性和回顾性队列研究表明，从APS实验室诊断标准中消除aCL和/或IgMβ2GPI或低阳性aCL或β2GPI阳性可能会导致相当多的妇女被认为患有产科APS。此类前瞻性和回顾性研究还表明，患有非标准产科APS的妇女可受益于低分子量肝素加小剂量阿司匹林的产科APS标准治疗，并具有良好的妊娠结局。因此，非标准的产科APS表现可能与临床有关，值得对治疗方法进行研究。与其他先兆子痫，胎盘介导的并发症和新生儿死亡率的妇女相比，产科APS的妇女似乎风险更高，而且长期发生血栓事件的风险也更高。这些观察结果是否适用于非标准产科APS妇女的预后。

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