阿斯匹靈及低分子量肝素同時合併奎寧與阿斯匹靈及低分子量肝素在反覆性流產合併抗磷脂症候群的孕婦比較懷孕結果

抗磷脂症候群是一種後天的免疫疾病，也被認為是造成反覆流產的重要原因之一。目前預防抗磷脂症候群的產科併發症，標準治療是用阿斯匹靈及低分子量肝素，但仍舊有20-30%抗磷脂症候群的孕婦，接受治療後有出現相關的併發症。奎寧是一種抗發炎抗血栓形成的藥物，同時也是被廣泛使用的免疫調節藥物，最近的回溯性研究認為，使用奎寧對抗磷脂症候群的產科併發症有助益。本研究透過統合分析的方式來探討是否在正規治療上，加入奎寧能否帶來更好的併發症預防效果。文獻探討設定在反覆性流產合併抗磷脂症候群的產婦，介入則是比較使用常規藥物及合併奎寧兩組。文章包含隨機對照試驗及回溯性研究。我們搜尋的資料庫包含EMBASE, PubMed, Cochrane Library。在文獻收集過程中，收錄文章內的參考文獻我們也會篩選。經過誤差風險評估工具評讀後，篩選品質優良文獻，再用統合分析方法分析數據。主要療效指標是討論額外使用奎寧是否對增進活產率。在本次統合分析結果中，收錄的三篇文獻中比較470位病人。可以發現加入奎寧那組有更好的活產率，在95%信賴區間裡風險比(Risk ratio)是 1.36(95% 信賴區間 1.05-1.76)。但是對出生體重及胎兒生產週數統計上沒有顯著差異。實證研究結果顯示，在使用阿斯匹靈及低分子量肝素同時合併奎寧可以提昇活產率，但對出生體重及胎兒生產週數則是無統計上差異。

Antiphospholipid syndrome (APS)‐related immune factors are considered as an important cause of recurrent spontaneous abortion (RSA). The current standard prevention of obstetric complications in patients with APS is combination of low-dose aspirin and low-molecular-weight- heparin (LMWH). However, 20-30% of women still experience refractory obstetrical APS. Recent retrospective studies showed a beneficial effect of hydroxychloroquine (HCQ) in APS due to its anti-inflammatory, immunomodulatory and antithrombotic properties. This study aimed to evaluate whether HCQ combined with asprin and LMWH can improve the live birth rate in patients with APS and RSA. The data were retrieved from the Cochrane Library, PubMed, and EMBASE. We collected data of randomized controlled trials and retrospective study of aspirin combined with LMWH for treatment of pregnant women with APS and RSA. The “Risk of Bias Assessment” tool and the “Newcastle‐Ottawa Scale” were used to evaluate the risk of bias and quality of the collected literature. The risk ratio (RR) and its 95% confidence interval (CI) were determined using meta-analysis. The primary outcomes of interest were live birth after treatment with HCQ. In our study, a total of 3 studies were included, comprising a total of 470 patients. The live birth rate in pregnant women with APS and RSA was higher with administration of HCQ combined with aspirin plus LMWH than with only aspirin and LMWH (Risk ratio 1.36(95% CI 1.05-1.76)( I2 = 0.71)) . But our findings did not find significant difference in gestational age of delivery and Neonatal birth weight between two groups. Our findings suggest a significant benefit of HCQ in addition to aspirin and heparin for patients with APS showing improvement on live birth rate. Besides, HCQ usage has no influence on gestational age at delivery and neonatal birth weight.