产科抗磷脂综合征诊治中需要探讨的问题
Chinese Journal of Clinical Obstetrics and Gynecology（2021）
Abstract
产科抗磷脂综合征(OAPS)的诊疗受到关注,指南及共识成为诊疗的依据.但非典型(NOAPS)、难治性以及伴有血小板减少的OAPS的治疗仍存在着困惑.国内外最新研究结果显示NOAPS的临床表现、实验室检测指标与标准OAPS均有明显不同,干预治疗可以获得相同的妊娠结局.aPLs阳性及不良孕史的NOAPS应按标准OAPS进行管理和治疗.难治性OAPS需重视孕前及孕早期不良结局风险因素的评估,孕前LDA联合羟氯喹治疗,合并SLE或既往血栓病史、三个抗体均阳性者孕期LMWH增加至治疗剂量,个体化加用低剂量激素、免疫球蛋白等治疗措施.APS伴发血小板减少在aPL阳性患者中增加了血栓及血栓相关并发症的风险,抗凝治疗是必要的.但诊治中需评估血小板减少的程度和下降趋势,寻找微血管疾病及器官受损的证据,并根据相关检查寻找血小板减少的原因指导治疗.
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