DIJAGNOSTIČKO-TERAPIJSKI PRISTUP TRUDNICAMA SUSPEKTNIM NA ANTIFOSFOLIPIDNI SINDROM

Marija Glasnović, Ivica Bošnjak, Aleksandar Včev, Maja Košuta, Bahrija Lenz, Elizabeta Glasnović-Horvatić

Antiphospholipid syndrome includes the presence of antiphospholipid antibodies, vascular thrombosis and reproductive function disturbances. The aim was to show our diagnostic and therapeutic experiences. 62 women were included in study, 32 with primary antiphospholipd syndrome (PAPS), and 30 with secondary antiphospholipid syndrome (SAPS). 36 were pregnant and studied prospectively throughout pregnancy and six weeks after the delivery. Lupus-anticoagulant (LA) was positive in 23 patients with PAPS (71.9%), and in 10 patients with SAPS (33.3%). In SAPS group anticardiolipin antibodies (aCL) was positive in 8 patients (26.6%) compared to PAPS group with 3 aCL positive patients (9.4%). Antibeta2glycoprotein1 (antiβ2GP1) was positive in 3 patients with PAPS. Complications in previous pregnancies were in 25 cases (69.4%) spontaneous abortion, in 7 cases (19.4%) preeclampsia with intrauterine growth restriction (IUGR) in 3 patients. In 4 cases the complication was fetal death in utero. Average pregnancy lasted 37,06±0,707 weeks. Therapy with low dose aspirin and low-molecular-weight heparin was successful in 97.2%.

Antifosfolipidni sindrom predstavlja pojavu antifosfolipidnih antitijela, vaskularne tromboze i pojavu problema s reprodukcijom žene. Cilj rada bio je prikazati naša iskustva u dijagnostici i liječenju ovog sindroma. U studiju je uključeno 62 bolesnica, 32 s primarnim (PAPS) i 30 sa sekundarnim antifosfolipidnim sindromom (SAPS). 36 bolesnica bilo je trudno, te prospektivno praćeno kroz trudnoću i šest postpartalnih tjedana. 23 bolesnice (71,9%) je bilo lupus-antikoagulant (LA) pozitivno u PAPS-u, a svega 10 (33,3%) u SAPSu. Antikardioplipin (aCL) je imao češću pojavu u SAPSu 8 (26,6%) u odnosu na PAPS 3 (9,4%). U tri bolesnice (3,3%) PAPS-u je dijagnosticiran pozitivnošću na antibeta2glikoprotein1 (antiβ2GP1). Najčešća manifestacija u prijašnjim trudnoćama bila je spontani abortus: 25 bolesnica (69,4%), preeklampsija 7 bolesnica (19,4%) koja je u tri bolesnice bila praćena unutarmaterničnim zastojem rasta (IUGR). U četiri bolesnice radilo se o intrauterinoj smrti fetusa (11,1%). Prosječna duljina trajanja trudnoće iznosila je 37,06±0,7 tjedana. Uspješnost terapije aspirinom i niskomolekularnim heparinom je bila 97,2%.