第一季度风险和阿司匹林坚持对早产子预防的综合影响
Daniel L Rolnik1, Min Yi Tan2, Argyro Syngelaki3
1Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
American journal of obstetrics and gynecology
|February 18, 2026
概括
阿司匹林在高风险妊娠中有效预防早产前 (PE),但其益处取决于坚持和预测的风险. 针对性预防通过专注于最有可能受益的女性来最大限度地提高效益.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 药理干预药理干预
背景情况:
- 早产前 (PE) 是高风险怀孕中的一个严重并发症.
- 已知阿司匹林可以预防PE,但其有效性受患者的坚持和基线风险的影响.
- 关于这些影响阿司匹林预防能力的程度存在不确定性.
研究的目的:
- 调查第一季度PE风险和阿司匹林坚持对阿司匹林预防功效的综合影响.
- 评估针对性与普遍性阿司匹林预防PE预防的益处和危害.
- 根据个体风险概况,确定怀孕期间使用阿司匹林的最佳策略.
主要方法:
- 来自ASPRE和SPREE队列的综合数据 (n=51,024个单独怀孕).
- 在妊娠11-13周使用胎儿医学基金会 (FMF) 竞争性风险模型进行早产儿科查.
- 蒙特卡洛模拟模型阿司匹林坚持场景 (完整的,基于试验的,50%的,可变的) 和估计风险降低 (RR),绝对风险降低 (ARR) 和需要治疗的数量 (NNT).
- 决策曲线分析,以评估针对性预防与普遍预防的净益.
主要成果:
- 阿司匹林的预防效果与坚持水平有显著的差异;完全坚持产生了最强的效果 (RR 0.25),而50%的坚持显示了较弱的效果 (RR 0.70).
- 在可变的坚持下,RR与基线风险非线性下降,在低风险的女性中显示出接近零的效应.
- 绝对效益 (ARR) 和NNT高度依赖于风险;NNT在低风险组中超过了几千个,即使坚持很高.
- 使用FMF模型的向预防证明了比通用治疗更大的净益,主要是通过减少不必要的干预措施.
结论:
- 阿司匹林在预防高风险的妇女早产前列腺方面非常有效.
- 在低风险人群中,阿司匹林的临床益处是可以忽略不计的,这强调了风险分层的重要性.
- 使用FMF模型的有针对性的查和治疗策略优化了临床益处,并最大限度地减少了不必要的阿司匹林暴露.
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