摘要:目的：低分子肝素+阿司匹林的治療對於20%的產科抗磷脂綜合征患者無效。他汀有保護內皮的功能，在動物模型中有助於改善妊娠預後。本研究將觀察普伐他汀對於低分子肝素+阿司匹林無效的產科抗磷脂綜合征患者預後的影響。
方法：納入21例在阿司匹林+低分子肝素治療期間發生先兆子癇或者宮內發育遲緩的抗磷脂綜合征患者。10例患者繼續應用上述治療，另外11例患者在發生先兆子癇或宮內發育遲緩時加用普伐他汀20m/天治療。比較兩組患者子宮胎盤血流動力學、高血壓、蛋白尿的變化以及胎兒的結局。
結果：對照組中，所有患者均早產，其中6例患者新生兒存活。存活的新生兒中3例發育異常。加用普伐他汀組患者胎盤血流和先兆子癇的表現均有改善。這些改善在加用普伐他汀10天後即可觀察到。加用普伐他汀組患者均為足月活產。
結論：本研究顯示，在先兆子癇或者宮內發育遲緩發生時即加用普伐他汀有助於改善難治性產科抗磷脂綜合征患者的預後。
附原文：
BACKGROUND: Administration of conventionalantithrombotic treatment (low-dose aspirin plus low-molecular weight heparin[LDA+LMWH]) for obstetric antiphospholipid syndrome (APS) does not preventlife-threatening placenta insufficiency-associated complications such aspreeclampsia (PE) and intrauterine growth restriction (IUGR) in 20% ofpatients. Statins have been linked to improved pregnancy outcomes in mousemodels of PE and APS, possibly due to their protective effects on endothelium.Here, we investigated the use of pravastatin in LDA+LMWH-refractory APS inpatients at an increased risk of adverse pregnancy outcomes.METHODS: We studied21 pregnant women with APS who developed PE and/or IUGR during treatment withLDA+LMWH. A control group of 10 patients received only LDA+LMWH. Elevenpatients received pravastatin (20 mg/d) in addition to LDA+LMWH at the onset ofPE and/or IUGR. Uteroplacental blood hemodynamics, progression of PE features(hypertension and proteinuria), and fetal/neonatal outcomes wereevaluated.RESULTS: In the control group, all deliveries occurred preterm andonly 6 of 11 neonates survived. Of the 6 surviving neonates, 3 showed abnormaldevelopment. Patients who received both pravastatin and LDA+LMWH exhibitedincreased placental blood flow and improvements in PE features. Thesebeneficial effects were observed as early as 10 days after pravastatintreatment onset. Pravastatin treatmentcombined with LDA+LMWH was alsoassociated with live births that occurred close to full term in allpatients.CONCLUSION: The present study suggests that pravastatin may improvepregnancy outcomes in women with refractory obstetric APS when taken at theonset of PE or IUGR until the end of pregnancy.
引自：Lefkou E,Mamopoulos A,Dagklis T，et al. Pravastatin improves pregnancy outcomes in obstetric antiphospholipidsyndrome refractory to antithrombotic therapy.J Clin Invest.2016 Aug 1;126 (8):2933-40.
