作者：Yu Song ，et al.
翻译：刘旭（40505236@qq.com）
译者简介: 河北保定解放军82集团军医院（原解放军252医院）中医康复科副主任医师。从事临床工作10余年，2017年9月至2018年3月曾于北医三院风湿免疫科进修，师从刘湘源教授，熟练掌握了免疫性不良妊娠的治疗。
【摘要】
背景：复发性流产合并抗磷脂综合征的治疗方案包括长期使用肝素和阿司匹林，从确认怀孕开始，持续到产后6周。本试验研究抗磷脂抗体滴度的变化与临床结局的关系，同时对缩短治疗方案的效果也进行了评估。
方法：对123例2012年3月至2014年5月复发性流产合并抗磷脂综合征患者进行前瞻性研究。怀孕前用低剂量泼尼松和阿司匹林对患者进行预处理，受孕后添加肝素，分析抗磷脂抗体水平和妊娠结局。
结果：所有患者均为抗β2 糖蛋白Ⅰ抗体IgM阳性，提前应用低剂量泼尼松和阿司匹林后，99名患者怀孕，其中87人成功分娩，12人流产，成功率为87.9%。活产组中，用药之前患者抗β2 糖蛋白Ⅰ抗体水平为56.8±49 RU/ml，用药2个月后抗β2 糖蛋白Ⅰ抗体水平为32.1±26 RU/ml,早孕期24.1±23.1 RU/m (P < 0.05)。流产组中，用药之前抗β2 糖蛋白Ⅰ抗体水平为52.8±30.7,用药后β2 糖蛋白Ⅰ抗体水平为38.5±34.2 RU/ml,早孕期33.9±24.7 RU/ml；在流产组中，抗磷脂抗体滴度降低低于活产组（P<0.05）。在24例未孕患者中，用药后平均抗体滴度没有下降（P=0.802）。
结论：1.β2 糖蛋白Ⅰ抗体IgM是复发性流产合并抗磷脂综合征患者的主要表现抗体；2.抗体滴度的降低与妊娠结局较好相关；3.较短的治疗方案经济有效。
附原文：
Background: The management of patients with recurrent miscarriage (RM) and antiphospholipid antibody syndrome (APS) includes prolonged treatment with heparin and aspirin , starting from the confirmation of pregnancy and continuing until 6 weeks after birth . This study was conducted to determine the relationship between changes in antiphospholipid antibody titers and clinical outcomes. The effect of a shortened treatment regimen was also evaluated .Methods : A prospective study of 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 before pregnancy, and heparin was added after conception. The levels of antiphospholipid 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 123 patients became pregnant ,and 87 of those pregnancies resulted in successful live births ,while 12 resulted in miscarriage ,showing a success rate of 87.9％.In the live birth group , 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 ± 34.2 RU/ml after pretreatment ,and 33.9 ± 24.7 RU/ml during early pregnancy ; the decrease in antiphospholipid antibodies was lower in the miscarriage group than in the live birth group (P ＜ 0.05).Of the 24 infertile patients,the average antibody titer did not decline after pretreatment (P =0.802).Conclusions:Anti-β2-GP1 IgM was the predominant form of antibody in patients with RM and APS. The decreases in antiphospholipid antibody titers correlated with better pregnancy outcomes. The shorter treatment regimen was effective and economical.
引自：
Song Y，et al. Antiphospholipid Antibody Titers and Clinical Outcomes in Patients with Recurrent Miscarriage and Antiphospholipid Antibody Syndrome: A Prospective Study[J]. Chin Med J (Engl), 2017, 130(3):267.