崔雪^1,,
周颖²,
张璐²,
石芳鑫^2,,
1. 大连医科大学附属第二医院 妇产科, 辽宁 大连 116027
2. 大连医科大学附属第一医院 妇产科, 辽宁 大连 116011

基金项目: 大连市医学科学研究计划项目(1912001)


详细信息 作者简介: 崔雪(1994-), 女, 住院医师。E-mail: 948593163@qq.com




通讯作者: 石芳鑫, 教授。E-mail: shifangxin1122@163.com 中图分类号: R714.7


摘要:目的探究影响妊娠合并抗磷脂综合征妊娠结局的相关因素，为孕期合理规范治疗及管理提供临床依据，以减少不良妊娠结局发生。方法收集2017年1月1日至2019年12月31日于大连医科大学附属第一医院产科分娩的抗磷脂综合征孕妇61例，平均(31.75±3.63)岁，孕次1~6次，中位孕次3次，产次0~3次，中位产次1次，均为单胎妊娠。分析孕妇的一般情况及妊娠结局。按是否发生不良妊娠结局分为不良结局组30例及无不良结局组31例，探究造成不良妊娠结局的危险因素。结果61例妊娠合并抗磷脂综合征孕妇中既往不良孕娩史者48例(78.7%)。狼疮抗凝物(lupus anticoagulant，LA)、抗心磷脂抗体(anticardiolipin，aCL)和aβ2糖蛋白Ⅰ(anti-β2 glycoprotein-Ⅰ，aβ2GPⅠ)抗体三种抗磷脂抗体中单阳46例(75.4%)，双阳和三阳分别为7例(11.5%)、8例(13.1%)，其中LA阳性58例(95.1%)。未规范用药28例(54.1%)。57例活产(93.4%)，活产孕妇分娩中位孕周38.29周，新生儿体重为(2 648.33±946.52)g，1分钟Apgar评分3~10分，中位评分10分。61例孕妇中发生子痫前期30例(49.2%)，胎盘早剥6例(9.8%)，胎儿生长受限(fetal growth restriction, FGR) 20例(32.8%)，胎儿丢失4例(6.6%)。不良结局组BMI高于无不良结局组；不良结局组中位孕次低于无不良结局组；不良结局组“＜10周流产2次”者0例小于无不良结局组11例(35.5%)；不良结局组未规范用药25例(83.3%)大于无不良结局组3例(9.7%)，差异均有统计学意义(P < 0.05)。多因素回归分析发现未规范用药为不良妊娠结局的独立危险因素，未规范用药的孕妇发生不良妊娠结局的相对危险度为规范用药者的46.667倍(P＜0.05)。结论妊娠合并抗磷脂综合征孕期规范应用低分子肝素和阿司匹林等药物治疗，可减少不良妊娠结局的发生；抗磷脂抗体单阳或多重阳性不能影响妊娠结局。
关键词: 抗磷脂综合征/
妊娠结局/
药物治疗


Abstract:ObjectiveTo explore the related factors that affect the pregnancy outcome in patients with antiphospholipid syndrome, and to provide clinical basis for the rational standardization of treatment and management during pregnancy in order to reduce the incidence of adverse pregnancy outcomes.MethodsThe clinical data of 61 pregnant women with antiphospholipid syndrome, who delivered in the Department of Obstetrics at the First Affiliated Hospital of Dalian Medical University from January 1, 2017 to December 31, 2019, were collected. The average age was (31.75±3.63) years. The number of pregnancies ranged from 1-6 times with a median of 3. The number of deliveries ranged from 0 to 3 times with a median of 1, all of which were singleton pregnancies. The general condition and pregnancy outcome of pregnant women were analyzed. According to whether there were adverse pregnancy outcomes, they were divided into 30 cases in the adverse outcome group and 31 cases in the non-adverse outcome group, to explore the risk factors that cause adverse pregnancy outcomes.ResultsAmong the 61 pregnant women with antiphospholipid syndrome, 48 (78.7%) had a history of adverse pregnancy and delivery. Among the three antiphospholipid antibodies of LA, aCL and anti-β2GPⅠ, 46 patients (75.4%) were single positive, 7 patients (11.5%) and 8 patients (13.1%) were double and triple positive respectively, of whom 58 patients (95.1%) were LA positive. Among them, 28 patients (54.1%) had no standardized treatment. There were 57 live births (93.4%), the median gestational age was 38.29 weeks, the neonatal weight was (2 648.33±946.52) g, the one-minute Apgar score was 3-10, and the median score was 10. Among the 61 pregnant women, 30 (49.2%) had preeclampsia, 6 (9.8%) had placental abruption, 20 (32.8%) had FGR, 4 had fetal loss (6.6%). BMI in the adverse outcome group was higher than that in the non-adverse outcome group. The median number of pregnancies in the adverse outcome group was lower than that in the non-adverse outcome group. The patients with "abortion more than 2 times within 10 weeks" in the adverse outcome group was less than those in the non-adverse outcome group. 25 patients (83.3%) had no standardized treatment in the adverse outcome group, which was significantly higher than 3 patients (9.7%) in the non-adverse outcome group. Multivariate regression analysis revealed that unstandardized treatment was a risk factor for adverse pregnancy outcomes. The relative risk of adverse pregnancy outcomes among pregnant women who had no standardized treatment was 46.667 times higher compared to those who had standardized treatment (P < 0.05).ConclusionThe standard application of low molecular weight heparin and aspirin and other drugs during pregnancy with antiphospholipid syndrome can reduce the occurrence of adverse pregnancy outcomes. Anti-phospholipid antibody single positive or multiple positives do not affect pregnancy outcomes.
Keywords:antiphospholipid syndrome/
pregnancy outcome/
medical treatment

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