プレドニゾロンと低分子ヘパリンで管理された抗PP1Pk抗体を持つ妊娠 - 症例報告と文献レビュー

Pregnancy with anti-PP1Pk antibody managed with prednisolone and low-molecular-weight heparin - A case report and literature review.

• Sara Nascimento
• Marta Rodrigues
• Manuel Gonçalves Henriques
• Fernanda Paixão Duarte
• António Barra
• Teresa Matos

抄録

抗PP1Pk抗体は、主に妊娠前半に再発流産を伴う稀な抗体です。抗体価と流産リスクとの間には直接的な相関関係があるようです。これは稀な疾患であるため、症例報告はほとんど発表されていません。最も頻繁に提案されている治療法は、二重濾過プラスマフェレーシスと血漿交換療法です。これらの治療法の背景にある理論的根拠は、母体循環から細胞障害性抗体を除去することである。ここでは、2回の自然流産の既往歴があり、妊娠前の抗PP1Pk抗体価が1:4であった30歳女性の症例を紹介する。妊娠するとすぐに、彼女はプレドニゾロンと低分子ヘパリン（LMWH）に置かれました。妊娠中ずっと隔週で抗体価を測定し、1:16以下の値を維持した。抗体価が低いと考えられたため、プラスマフェレーシスは実施されなかった。妊娠は何事もなく、妊娠37週目に貧血の兆候もなく健康な新生児を出産しました。

The anti-PP1Pk is a rare antibody associated with recurrent miscarriages, mainly in the first half of pregnancy. There seems to be a direct correlation between the antibody titer and risk of miscarriage. As this is a rare entity, few case reports have been published. The most frequently proposed therapeutic approaches are double-filtration plasmapheresis and plasma exchange therapy. The rationale behind them is to remove the cytotoxic antibodies from maternal circulation. Here, we present the case of a 30-year-old woman with a history of two spontaneous miscarriages and a pre-conception anti-PP1Pk antibody titer of 1:4. As soon as she became pregnant, she was placed on prednisolone and low-molecular-weight heparin (LMWH). Biweekly antibody titers were performed throughout the entire gestation and remained below 1:16. As the titers were considered to be low, plasmapheresis was not performed. The pregnancy was uneventful and she delivered a healthy newborn child at 37 weeks of gestation, with no signs of anaemia.

© 2020 The Authors.