个体化免疫抑制-抗凝疗法在抗心磷脂抗体阳性复发性流产患者治疗中的应用

The application of individualised immune-suppression and anticoagulant in therapy of RSA with ACA.

目的探讨小剂量、短疗程、个体化的免疫抑制和抗凝疗法对抗心磷脂抗体(ACA)阳性复发性流产患者治疗的安全性和有效性。方法2005-01-2006-06对上海交通大学医学院附属仁济医院55例抗心磷脂抗体阳性复发性流产患者,选用阿司匹林、泼尼松和肝素药物治疗。采用ACA、抗β2-糖蛋白-1抗体、血小板聚集试验、血浆α-颗粒膜蛋白、D-二聚体和部分凝血活酶时间等指标测定,对用药前后患者体内的抗心磷脂抗体、血小板激活和血凝情况进行动态观察,以调整合理用药组合方案、剂量和疗程。结果构建了阿司匹林,泼尼松,阿司匹林+肝素,阿司匹林+泼尼松,泼尼松+肝素,阿司匹林+肝素+泼尼松等6种治疗方案,实现了治疗的小剂量、短疗程和个体化。妊娠成功率达92.59%,且无明显副反应。结论对抗心磷脂抗体阳性复发性流产患者,小剂量、短疗程、个体化的免疫抑制和抗凝疗法比以往所报道的治疗方案更有效、更安全。

Objective To investigate the efficacy and safety of the individulised therapy with low dose and short course of immune-suppression and anticoagulant for recurrent spontaneous abortion women with anticardiolipin antibody. Methods From January of 2005 to June of 2006, fifty-five recurrent spontaneous abortion women with anticardiolipin antibody in Shanghai Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University received aspirin, prednisone and heparin. We selected ACA, β2-GP-1 antibody, PAGT, GMP-140, D-dimer and APTT, as index for monitoring anticardiolipin antibody level, platelet activation and coagulation, and adjusting the therapeutic regimen, dose and course. Resuits The regimen included ： aspirin, prednisone,aspirin ＋ heparin, aspirin ＋ prednisone, prednisone ＋ heparin, aspirin ＋ heparin ＋ prednisone. There were 50 live birth in 55 pregnancy, the live-birth rate was 92.59% （ exclude 1 pregnancy loss with fetal chromosome aberration）. There were no case of significant adverse effects to be found. Conclusion The individual therapy for low dose and short course of immune-suppression and anticoagulant is more effective and safe than those reported before to reduce pregnancy loss with anticardiolipin antibody.