徐烯鑫,陈鲜霞

抗磷脂综合征（Antiphospholipid Syndrome，APS）是自身免疫性疾病的一类，以反复血管内血栓形成以及病理妊娠为其常见的临床表现，实验室检查以抗磷脂抗体（aPLs）持续阳性为特征。APS患者的病理妊娠主要表现为复发性流产、胎死宫内、胎儿生长受限、子痫前期、早产等。子宫动脉（UtA）、胎儿脐动脉（UMA）、大脑中动脉（MCA）血流参数的改变可以反映胎盘-胎儿循环状态，对评估胎儿在母体宫内发育情况及预测抗磷脂综合征患者妊娠结局具有较大意义。本文对孕晚期UtA、UMA、MCA在APS患者妊娠结局中的预测价值研究进展进行综述，旨在为APS患者的孕期监测及临床干预提供参考。

妊娠结局；抗磷脂综合征；子宫动脉；大脑中动脉；脐动脉

[1] 颜丽,刘晓晨,葛明秀,等.超声检测妊娠早期子宫动脉频谱预测抗磷脂抗体综合征患者妊娠结局的价值[J].医学影像学杂志, 2024,34(06):94-97. [2] 于若寒,孙琳,刘湘源.产科抗磷脂综合征与复发性流产的研究进展[J].发育医学电子杂志,2017,5(02):122-125. [3] 霍荣秀.抗磷脂综合征患者不良妊娠结局的危险因素分析[D].山西医科大学,2022. [4] Miyakis S,Lockshin MD,Atsumi T,Branch DW,et al.International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome(APS).J Thromb Haemost.2006 Feb;4(2):295-306. [5] 崔雪.抗磷脂综合征妊娠结局及其相关因素的临床分析[D].大连医科大学,2020. [6] PELUSA H F,PEZZARINI E,BASIGLIO C L,et al.Antiphospholipid and antioangiogenic activity in females with recurrent miscarriage and antiphospholipid syndrome[J].Annals of clinical biochemistry,2017,54(5):577-83. [7] EISNER D A,CALDWELL J L,KISTAMAS K,et al.Calcium and Excitation-Contraction Coupling in the Heart[J].Circ Res, 2017,121(2):181-95. [8] 李晓琴,林叶.彩色多普勒超声在评估孕晚期FGR中的应用价值[J].西南国防医药,2018,28(8):723-726. [9] 任秀娥,王卓,郑晓芳,等.高危妊娠晚期胎儿脐动脉、大脑中动脉血流多普勒参数变化与不良妊娠结局的关系[J].影像科学与光化学,2020,38(03):447-452. [10] 朱晓青,李勇裴,赵丽燕,等.孕晚期胎儿超声参数与不良妊娠结局的相关性及其预测价值[J].中华全科医学,2019, 17(9):1554-1556,1608. [11] 陈晶晶.超声检测妊娠早期子宫动脉血流在抗磷脂综合征患者中的应用价值[D].温州医科大学,2022. [12] Sayar Z,Moll R,Isenberg D,et al.Thrombotic antiphospholipid syndrome:a practical guide to diagnosis and management[J].Thromb Res,2021,198:213-221. [13] Xourgia E,Tektonidou MG.An update on antiphospholipid syndrome[J].Curr Rheumatol Rep,2021,23(12):84. [14] 刘亚敏,周玮.妊娠合并灾难性抗磷脂综合征[J].中国实用妇科与产科杂志,2024,40(12):1183-1186. [15] 赵久良,沈海丽,柴克霞,等.抗磷脂综合征诊疗规范[J].中华内科杂志,2022,61(9):1000-1007. [16] Miyakis S,Lockshin MD,Atsumi T,Branch DW,et al.International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome(APS).J Thromb Haemost.2006 Feb;4(2):295-306. [17] 李晓东.非典型产科抗磷脂综合征患者的临床特点及妊娠结局分析[D].大连医科大学,2023. [18] Barbhaiya M,Zuily S,Naden R,et al.2023 ACR/EULAR antiphospholipid syndrome classification criteria[J].Ann Rheum Dis, 2023,82(10):1258-1270. [19] 哈思瑶,陈慧.产科抗磷脂综合征的诊断[J].实用妇产科杂志,2023,39(12):886-890. [20] Saccone G,Berghella V,Maruotti GM,et al.Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome,the PREGNANTS study[J].Am J Obstet Gynecol,2017,216(5):525.e1-525.e12. [21] VIALL C A,CHAMLEY LW.Histopathology in the placentae of women with antiphospholipid antibodies:A systematic review of the literature[J].Autoimmun Rev,2015,14(5):446-471. [22] SIMOPOULOU M,SFAKIANOUDIS K,MAZIOTIS E,et al.The Impact of Autoantibodies on IVF Treatment and Outcome:A Systematic Review[J].Int J Mol Sci,2019,20(4). [23] STERN C,CHAMLEY L.Antiphospholipid antibodies and coagulation defects in women with implantation failure after IVF and recurrent miscarriage[J].Reprod Biomed Online,2006,13(1):29-37. [24] 易雪.超声诊断与胎儿生长受限[D].昆明医科大学,2024. [25] 刘冰冰.基于超声血流参数的胎儿生长受限辅助诊断预测构建及机器学习算法模型[D].新乡医学院,2024. [26] 王丽旻.超声检测孕妇及胎儿主要血流参数在妊高症中的应用价值[D].大连医科大学,2021. [27] 陈江红.脐动脉联合胎儿大脑中动脉检测对胎儿缺氧的诊断价值[D]:河北医科大学,2015. [28] 康怡娟.多普勒超声检测大脑中动脉及脐动脉对胎儿宫内缺氧的价值[D].大理大学,2023. [29] 杨敏燕,葛红山,张超逸,等.子宫动脉RI、PI、S/D参数预测妊娠合并抗磷脂综合征患者胚胎停育的临床价值[J].中外医学研究, 2022,20(35):59-63. [30] MAHMOOD W H W,ISLAM M A,ABDULLAH M A,et al.Anti-annexin A5,Antiphosphatidylinositol antibodies,and haematological parameters in preeclampsia patients:a casecontrol study[J].Current Women’s Health Reviews,2021,17(1):36-40. [31] TOK A,BEYOLU A.Antenatal and postpartum comparison of HD-OCT findings of macula,retinal nerve fiber layer,ganglion cell density between severe preeclampsia patients and healthy pregnant woman[J].Hypertension in pregnancy,2020,39(3):252-259. [32] 颜媛,邹翰琴,周克松,等.胎儿脐动脉、肾动脉及大脑中动脉血流动力学与胎儿宫内缺氧的相关性研究[J].四川医学, 2018,39(09):1057-1060. [33] 郭晓玥,邵珲,王妍,等.胎儿缺氧的妊娠期监测[J].中国妇产科临床杂志,2017,18(04):366-368. [34] 刘平,樊尚荣.产科抗磷脂综合征的诊断和治疗[J].中华产科急救电子杂志,2019,8(02):87-92. [35] 陈烨,南瑞霞.胎儿生长受限严重不良妊娠结局与血流异常关系的超声研究[J].海南医学,2023,34(11):1616-1619. [36] 王丽,胡春霞,万映,等.超声监测胎儿大脑中动脉血流在晚孕期对评估胎儿方面的临床意义[J].中国优生与遗传杂志, 2018,26(09):51-52. [37] CIOBANU A,WRIGHT A,SYNGELAKI A,et al.Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio[J].Ultrasound Obstet Gynecol,2019,53(4):465-472. [38] GIUSSANI D A.The fetal brain sparing response to hypoxia:physiological mechanisms[J].J Physiol,2016,594(5):1215-1230. [39] HERSHKOVITZ R,KINGDOM J C,GEARY M,et al.Fetal cerebral blood flow redistribution in late gestation:identification of compromise in small fetuses with normal umbilicalartery Doppler[J].Ultrasound Obstet Gynecol,2000,15(3):209-212.

点击下载PDF