懷孕期間抗磷脂症候群之治療－病例報告

目的：抗磷脂症候群為一自體免疫性疾病，女性約佔八成，多在育齡時發病。其臨床特色為：動靜脈血栓、反覆性流產及血小板低下。過去，抗磷脂症候群的婦女成功懷孕並生下胎兒的機率只有20－30％，隨著對此疾病的研究進展及治療，懷孕過程中使用藥物如：低劑量阿斯匹靈、維他命K拮抗劑、羥氯奎寧、直接口服抗凝血劑、肝素、類固醇、免疫抑制劑及靜脈注射免疫球蛋白等治療可使懷孕成功率提升至70-80％。本文將描述抗磷脂抗體造成流產的可能致病機轉及經驗性治療。病例報告：本文報告一名抗磷脂症候群的育齡婦女在流產三次後，經藥物治療成功產子的案例。結論：對反覆性流產的抗磷脂症候群孕婦，治療方式尚未有一定的準則，但已逐漸形成共識，建議謹慎評估此類病人、及時轉介相關專科例如血液科或是過敏免疫風濕科，找出最適合病人的治療方式。

關鍵字

抗磷脂症候群；抗磷脂抗體；反覆性流產；羥氯奎寧

並列摘要

Objective: Antiphospholipid syndrome is an autoimmune disease featured with recurrent venous or arterial thrombosis, thrombocytopenia, and/or pregnancy losses. The miscarriages rate in pregnant women with the antiphospholipid syndrome was up to 70-80% in the past. The successful delivery rate in obstetrical antiphospholipid syndrome has evaluated to 70-80% along with the disease and treatment advancement; the drug used include low-dose aspirin, vitamin K antagonist, hydroxychloroquine, and direct oral anticoagulants, heparin, steroid, immunosuppressants, and intravenous immunoglobulin. This article describes the possible mechanisms by which antiphospholipid antibodies cause pregnancy losses and the details of empirical treatments. Case Report: We reported a female patient with antiphospholipid syndrome, with three times of recurrent pregnancy losses who succeeded in giving birth after drug treatment. Conclusion: There is no standard treatment for pregnant women with recurrent pregnancy losses, but a consensus has started. We recommend a careful evaluation of these patients and transfer them to appropriate related departments, e.g., hematology department or rheumatology department, to work out optimal treatment modalities.

並列關鍵字

antiphospholipid syndrome ； antiphospholipid antibody ； recurrent pregnancy loss ； hydroxychloroquine

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懷孕期間抗磷脂症候群之治療－病例報告

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