产科中的羟氯喹:妊娠期胎盘功能不全预防性使用羟氯喹的潜在影响》。

IF 2 Q2 OBSTETRICS & GYNECOLOGY Obstetrics and Gynecology Science Pub Date : 2024-03-01 Epub Date: 2024-01-19 DOI:10.5468/ogs.23252
Yoo-Min Kim, Ji-Hee Sung, Hyun-Hwa Cha, Soo-Young Oh
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引用次数: 0

摘要

孕早期适当的胎盘植入是维持孕期健康的关键因素。胎盘功能不全可导致子痫前期、胎儿生长受限和胎儿死亡等严重并发症。这些并发症通常与子宫肌层螺旋动脉重塑受限和阻塞性病变的病理结果有关,这些病变在以后的妊娠中复发率很高。目前,除阿司匹林外,还没有其他药物干预措施来预防子痫前期。羟氯喹(HCQ)是一种著名的抗疟药物,可减少血管的炎症和血栓变化。几十年来,使用 HCQ 治疗自身免疫性疾病已成功预防了动脉和静脉血栓事件,并已扩展到治疗妊娠期狼疮和抗磷脂抗体综合征。HCQ 可将狼疮先兆子痫的风险降低高达 90%。最近有几项研究调查了 HCQ 是否能改善有不良妊娠结局病史的妇女的妊娠结局。此外,体外和动物实验也证明了 HCQ 在改善内皮功能障碍、缓解高血压和蛋白尿方面的有益作用。因此,我们假设 HCQ 有可能减轻与胎盘功能不全相关的血管炎症和血栓形成途径,并在韩国开展了一项多中心临床试验,研究阿司匹林与 HCQ 联合使用对子痫前期高危妊娠的疗效。本研究总结了 HCQ 对胎盘功能不全妊娠的潜在影响,以及 HCQ 治疗在产科领域的意义。
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Hydroxychloroquine in obstetrics: potential implications of the prophylactic use of hydroxychloroquine for placental insufficiency during pregnancy.

Proper placentation during early pregnancy is a key factor for maintaining a healthy pregnancy. Placental insufficiency leads to critical complications such as preeclampsia, fetal growth restriction, and fetal demise. These complications are often associated with pathological findings of restricted remodeling and obstructive lesions of the myometrial spiral arteries, which have high recurrence rates during subsequent pregnancies. Currently, there are no pharmacological interventions other than aspirin for the prevention of preeclampsia. Hydroxychloroquine (HCQ), a well-known antimalarial drug, reduces inflammatory and thrombotic changes in vessels. For decades, the use of HCQ for autoimmune diseases has resulted in the successful prevention of both arterial and venous thrombotic events and has been extended to the treatment of lupus and antiphospholipid antibody syndrome during pregnancy. HCQ reduces the risk of preeclampsia with lupus by up to 90%. Several recent studies have investigated whether HCQ improves pregnancy outcomes in women with a history of poor outcomes. In addition, in vitro and animal studies have demonstrated the beneficial effects of HCQ in improving endothelial dysfunction and alleviating hypertension and proteinuria. Therefore, we hypothesized that HCQ has the potential to attenuate the vascular inflammatory and thrombogenic pathways associated with placental insufficiency and conducted a multicenter clinical trial on the efficacy of combining aspirin with HCQ for pregnancies at high risk for preeclampsia in Korea. This study summarizes the potential effects of HCQ on pregnancies with placental insufficiency and the implications of HCQ treatment in the field of obstetrics.

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来源期刊
Obstetrics and Gynecology Science
Obstetrics and Gynecology Science Medicine-Obstetrics and Gynecology
CiteScore
3.80
自引率
15.80%
发文量
58
审稿时长
16 weeks
期刊介绍: Obstetrics & Gynecology Science (NLM title: Obstet Gynecol Sci) is an international peer-review journal that published basic, translational, clinical research, and clinical practice guideline to promote women’s health and prevent obstetric and gynecologic disorders. The journal has an international editorial board and is published in English on the 15th day of every other month. Submitted manuscripts should not contain previously published material and should not be under consideration for publication elsewhere. The journal has been publishing articles since 1958. The aim of the journal is to publish original articles, reviews, case reports, short communications, letters to the editor, and video articles that have the potential to change the practices in women''s health care. The journal’s main focus is the diagnosis, treatment, prediction, and prevention of obstetric and gynecologic disorders. Because the life expectancy of Korean and Asian women is increasing, the journal''s editors are particularly interested in the health of elderly women in these population groups. The journal also publishes articles about reproductive biology, stem cell research, and artificial intelligence research for women; additionally, it provides insights into the physiology and mechanisms of obstetric and gynecologic diseases.
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