抗脂综合征的新ACR/EULAR 2023分类标准:2025年妇科医生应该知道什么
Anne Murarasu1, Grégoire Martin de Frémont2, Gaelle Guettrot-Imbert2
1Service de Médecine Interne Immunologie Clinique, CHRU Tours, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, équipe ECAMO, Centre for Research in Epidemiology and Statistics (CRESS), Paris, France.
Journal of gynecology obstetrics and human reproduction
|December 21, 2025
概括
针对抗脂综合征 (APS) 的2023年新分类标准提高了产科APS的特异性,改善了试验的一致性. 临床医生应仔细考虑在这些标准之外的患者的治疗.
科学领域:
- 类风湿病学 类风湿病学
- 产科 产科 产科 产科 产科
- 免疫学 免疫学 免疫学
背景情况:
- 抗脂综合征 (APS) 是通过与抗脂抗体 (aPL) 相关的血栓和产科事件来定义的.
- 以前对APS表现的定义导致了异质的研究组和不一致的数据,特别是对于产科APS.
- 产科APS经常导致严重的孕前和胎盘缺陷,影响胎儿和母亲的健康.
研究的目的:
- 评估2023年美国风湿病学院和欧洲抗风湿联盟对APS的分类标准的影响.
- 评估这些新标准的影响,特别是对于产科APS及其相关表现.
- 突出狼抗凝剂作为APS的重要危险因素的重要性.
主要方法:
- 对新引入的2023年APS分类标准进行审查和分析.
- 对比新标准的重点在于特异性与敏感性.
- 检查特定的aPL和临床表现的修订意义,包括孤立的胎儿死亡.
主要成果:
- 2023年标准优先考虑特异性,旨在在APS试验中使研究人群更加均,特别是在产科APS中.
- 在新的标准下,孤立的胎儿死亡没有妊娠前或胎盘缺陷在新标准下具有较小的意义.
- 狼抗凝剂被确定为APS患者血栓形成和不良产科结果的主要危险因素.
- 某些孤立的抗体发现 (例如,低位数IgG aCL或抗β2GPI,IgM aPL) 不再足以进行APS分类.
- 在APS患者的怀孕中,特别是那些患有狼抗凝剂的患者,尽管接受了治疗,但仍存在高风险的并发症.
结论:
- 预计2023年APS分类标准将改善APS研究的同质性,特别是对于产科症状.
- 这些标准是为分类而不是诊断而设计的;临床判断对于管理新标准之外的患者至关重要.
- 了解aPL概况对于临床决策和关于治疗风险和益处的患者咨询仍然很重要.
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