背景：複發性流產合並抗磷脂綜合征的治療方案包括長期使用肝素和阿司匹林，從確認懷孕開始，持續到產後6周。本試驗研究抗磷脂抗體滴度的變化與臨床結局的關係，同時對縮短治療方案的效果也進行了評估。

        方法：對123例2012年3月至2014年5月複發性流產合並抗磷脂綜合征患者進行前瞻性研究。懷孕前用低劑量潑尼鬆和阿司匹林對患者進行預處理，受孕後添加肝素，分析抗磷脂抗體水平和妊娠結局。

        結果：所有患者均為抗β2 糖蛋白Ⅰ抗體IgM陽性，提前應用低劑量潑尼鬆和阿司匹林後，99名患者懷孕，其中87人成功分娩，12人流產，成功率為87.9%。活產組中，用藥之前患者抗β2 糖蛋白Ⅰ抗體水平為56.8±49 RU/ml，用藥2個月後抗β2 糖蛋白Ⅰ抗體水平為32.1±26RU/ml，早孕期24.1±23.1RU/m (P <0.05)。流產組中，用藥之前抗β2 糖蛋白Ⅰ抗體水平為52.8±30.7，用藥後β2 糖蛋白Ⅰ抗體水平為38.5±34.2 RU/ml，早孕期33.9±24.7RU/ml;在流產組中，抗磷脂抗體滴度降低低於活產組(P<0.05)。在24例未孕患者中，用藥後平均抗體滴度沒有下降(P=0.802)。

        結論：

        1.β2 糖蛋白Ⅰ抗體IgM是複發性流產合並抗磷脂綜合征患者的主要表現抗體;

        2.抗體滴度的降低與妊娠結局較好相關;

        3.較短的治療方案經濟有效。

        原 文

        Abstract

        Background:The management of patients with recurrent miscarriage (RM) and antiphospholipidantibody syndrome (APS) includes prolonged treatment with heparin and aspirin ,starting from the confirmation of pregnancy and continuing until 6 weeks afterbirth . This study was conducted to determine the relationship between changesin antiphospholipid antibody titers and clinical outcomes. The effect of ashortened treatment regimen was also evaluated .

        Methods : A prospective studyof 123 patients with RM and APS between March 2012 and May 2014 was conducted .Patients were pretreated with a low dose of prednisone plus aspirin beforepregnancy, and heparin was added after conception. The levels ofantiphospholipid antibodies and pregnancy outcomes were evaluated.

        Results :All patients were positive for anti-β2-glycoprotein 1 (anti-β2-GP 1) IgM .After prepregnancy treatment with low-dose prednisone plus aspirin,99 of 123patients became pregnant ,and 87 of those pregnancies resulted in successfullive births ,while 12 resulted in miscarriage ,showing a success rate of 87.9%.In the live birthgroup , levels of anti-β2-GP1 were 56.8 ± 49.0 RU/ml before the pretreatment regimen,32.1 ± 26.0 RU/ml after 2 months of pretreatment ,and 24.1 ± 23.1 RU/ml during early pregnancy (P <0.05).In the miscarriage group , antiphospholipid antibody titers were 52.8 ± 30.7 RU/ml before pretreatment,38.5 ± 34.2RU/ml after pretreatment ,and 33.9 ± 24.7 RU/ml duringearly pregnancy ; the decrease in antiphospholipid antibodies was lower in themiscarriage group than in the live birth group (P <0.05).Of the 24 infertile patients,the average antibody titer did not declineafter pretreatment (P =0.802).

        Conclusions:Anti-β2-GP1IgM was the predominant form of antibody in patients with RM and APS. Thedecreases in antiphospholipid antibody titers correlated with better pregnancyoutcomes. The shorter treatment regimen was effective and economical.

        引自：SongY，etal. Antiphospholipid Antibody Titers and Clinical Outcomes in Patients withRecurrent Miscarriage and Antiphospholipid Antibody Syndrome: A ProspectiveStudy[J]. Chin Med J (Engl), 2017, 130(3):267.