【孕早期狼疮抗凝物阳性…危险因素

孕早期狼疮抗凝物阳性、疾病活动及低补体血症是预测狼疮患者妊娠丢失的危险因素

作者：Mankee A，et al.
翻译：北医三院邓晓莉（m13683657545@163.com）
发布：孙琳 审核：姚中强


目的：既往研究发现蛋白尿、抗磷脂综合征、血小板减少以及高血压是红斑狼疮患者妊娠丢失的危险因素，也有研究发现仅仅狼疮抗凝物阳性是唯一的危险因素。本研究目的是分析狼疮抗凝物的预测价值。
方法：共纳入175例患者共202次妊娠，并在孕早期检测狼疮抗凝物。根据潜在的危险因素对患者进行分组，并分别计算各组中妊娠丢失患者的比例。狼疮抗凝物的检测采用DRVVT方法，有合适的混合时间以及确证实验。
结果：在孕早期狼疮抗凝物阳性的患者中，6/16（38%）出现妊娠丢失，阴性患者为16/186（9%）(p=0.003)。此外，合并低补体血症以及高疾病活动度的患者妊娠丢失率也越高（P值分别为0.049以及0.005）。相反，孕早期抗心磷脂抗体阳性与妊娠丢失没有显著相关性。
结论：狼疮抗凝物阳性是最强的预测狼疮妊娠丢失的孕早期危险因素。此外，孕早期医生整体评价的中度疾病活动度以及低补体血症也是预测妊娠丢失的预测因素。研究提示，在狼疮抗凝物阳性的红斑狼疮患者中，即使没有妊娠丢失病史也应该考虑抗凝治疗。





附原文：
INTRODUCTION: Multiple factors, including proteinuria, antiphospholipidsyndrome, thrombocytopenia and hypertension, are predictive of pregnancy lossin systemic lupus erythematosus (SLE). In the PROMISSE study of predictors ofpregnancy loss, only a battery of lupus anticoagulant tests was predictive of acomposite of adverse pregnancy outcomes. We examined the predictive value ofone baseline lupusanticoagulant test (dilute Russell vipervenom time) with pregnancy loss in women with SLE. METHODS: From the Hopkins Lupus Cohort, there were 202pregnancies from 175 different women after excluding twin pregnancies andpregnancies for which we did not have a first trimester assessment of lupusanticoagulant. We determined the percentage of women who had a pregnancy lossin groups defined by potential risk factors. The lupus anticoagulant wasdetermined by dilute Russell viper venom time with appropriate mixing andconfirmatory testing. Generalised estimating equations were used to calculate pvalues, accounting for repeated pregnancies in the same woman.
RESULTS: The age at pregnancy was <20 years (2%), 20-29 (53%), 30-39 (41%) and >40 (3%). 55% were Caucasian and 34% African-American. Among those with lupus anticoagulant during the first trimester, 6/16 (38%) experienced a pregnancy loss compared with only 16/186 (9%) of other pregnancies (p=0.003). In addition, those with low complement or
higher disease activity had a higher rate of pregnancy loss than those without
(p=0.049 and 0.005, respectively). In contrast, there was no association between elevated anticardiolipin in the first trimester and pregnancy loss. CONCLUSIONS: The strongest predictor of pregnancy loss in SLE in the first trimester is the lupus anticoagulant. In addition, moderate disease activity by the physician global assessment and low complement measured in the first trimester were predictive of pregnancy loss. These data suggest that treatment of the lupus anticoagulant could be considered, even in the absence of history of pregnancy loss.

引自：
Mankee A, Petri M, Magder LS. Lupus anticoagulant, disease activity and low complement in the first trimester are predictive of pregnancy loss. Lupus Sci Med. 2015 Dec 9; 2(1): e000095.


译者介绍：邓晓莉


邓晓莉，女，医学博士，副教授，北京大学第三医院风湿免疫科副主任医师。北京医学会风湿病学分第四届委员会第二届中青年委员会委员。2005年毕业于北京大学医学部临床医学系。毕业后一直在北京大学第三医院工作至今。 2012年赴美学习一年。主要研究系统性红斑狼疮、抗磷脂综合征、血管炎、白塞病等多种风湿免疫病的诊断和治疗。目前主要负责免疫吸附对重症狼疮的治疗研究、狼疮心血管并发症的相关研究，并参与国家11.5重点支撑项目“系统性红斑狼疮的诊断、治疗综合研究”、狼疮肾炎的强化治疗以及巨细胞病毒与狼疮发病的相关性研究。发表国内学术文章数十篇，其中SCI检索文章数篇。参与编写和翻译了《图表式临床风湿病学》、《类风湿关节炎》和《关节炎诊断与治疗》。