小剂量阿司匹林在子痫前期预防中的研究进展

doi:10.12280/gjfckx.20240369

摘要/Abstract

摘要：

阿司匹林（aspirin）具有抗炎、解热镇痛和抗血小板聚集等作用。研究表明妊娠期服用低剂量阿司匹林可以有效降低高危孕妇子痫前期（preeclampsia，PE）的发生，目前已广泛应用于临床。但关于阿司匹林应用标准目前国内外指南尚未达成共识，临床上可能存在扩大适应证或盲从使用的情况，无法达到预期理想效果。基于国内外指南及专家学者推荐意见，对小剂量阿司匹林（low-dose aspirin）预防PE的适用人群、用药时机、推荐剂量及用药过程中的注意事项等进行综述，以更好地指导临床工作。

关键词: 先兆子痫, 阿司匹林, 妊娠, 高危, 治疗, 准则

Abstract:

Aspirin prossesses anti-inflammatory, antipyretic, analgesic and antiplatelet aggregation properties. Studies have shown that taking low-dose aspirin during pregnancy can effectively reduce the incidence of preeclampsia (PE) in high-risk pregnant women, and it is now widely used in clinical practice. However, there is still no consensus on the standard for aspirin use in both domestic and international guidelines, leading to possible overextension of indications or blind use in clinical practice, which may prevent achieving the desired outcomes. Based on domestic and international guidelines and recommendations from experts and scholars, this review focuses on the applicable population, timing of administration, recommended dosage and precautions during the use of low-dose aspirin for the prevention of PE, aiming to better guide clinical practice.

Key words: Pre-eclampsia, Aspirin, Pregnancy, high-risk, Therapy, Guideline

邓玲玲, 伍绍文, 张为远. 小剂量阿司匹林在子痫前期预防中的研究进展[J]. 国际妇产科学杂志, 2024, 51(5): 515-518.

DENG Ling-ling, WU Shao-wen, ZHANG Wei-yuan. Research Progress on Low-Dose Aspirin in the Prevention of Preeclampsia[J]. Journal of International Obstetrics and Gynecology, 2024, 51(5): 515-518.

参考文献 37

[1]	Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin[J]. Am J Obstet Gynecol, 2022, 226(2S):S1108-S1119. doi: 10.1016/j.ajog.2020.08.045.
[2]	周玮, 漆洪波. 美国预防服务工作组阿司匹林预防子痫前期及相关母儿并发症的推荐[J]. 实用妇产科杂志, 2022, 38(5):346-349.
[3]	何国琳, 刘兴会. 产科医生眼中的子痫前期[J]. 四川大学学报(医学版), 2022, 53(6):1003-1006. doi: 10.12182/20221160203.
[4]	李健鑫, 陈真, 漆洪波. 阿司匹林预防子痫前期:从证据到应用规范[J]. 中华围产医学杂志, 2024, 27(4):265-271. doi: 10.3760/cma.j.cn113903-20240115-00024.
[5]	Goodlin RC, Haesslein HO, Fleming J. Aspirin for the treatment of recurrent toxaemia[J]. Lancet, 1978, 2(8079):51. doi: 10.1016/s0140-6736(78)91367-3. pmid: 78253
[6]	Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention[J]. Int J Gynaecol Obstet, 2019, 145(Suppl 1):1-33. doi: 10.1002/ijgo.12802.
[7]	Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222[J]. Obstet Gynecol, 2020, 135(6):e237-e260. doi: 10.1097/AOG.0000000000003891.
[8]	中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020)[J]. 中华妇产科杂志, 2020, 55(4):227-238. doi: 10.3760/cma.j.cn112141-20200114-00039.
[9]	Davidson KW, Barry MJ, Mangione CM, et al. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement[J]. JAMA, 2021, 326(12):1186-1191. doi: 10.1001/jama.2021.14781. pmid: 34581729
[10]	Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice[J]. Pregnancy Hypertens, 2022, 27:148-169. doi: 10.1016/j.preghy.2021.09.008.
[11]	Richards E, Giorgione V, Stevens O, et al. Low-dose aspirin for the prevention of superimposed preeclampsia in women with chronic hypertension: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2023, 228(4):395-408. doi: 10.1016/j.ajog.2022.09.046.
[12]	陈维, 王子莲. 阿司匹林预防子痫前期及其作用机制的研究进展[J]. 中华围产医学杂志, 2020, 23(7):492-495. doi: 10.3760/cma.j.cn113903-20191015-00592.
[13]	Hantoushzadeh S, Behzadian A, Mehdi Hasheminejad M, et al. Aspirin administration from early pregnancy versus initiation after 11 weeks of gestation for prevention of pre-eclampsia in high-risk pregnant women: Study protocol for randomized controlled trial[J]. Int J Reprod Biomed, 2024, 22(1):69-80. doi: 10.18502/ijrm.v22i1.15244. pmid: 38544665
[14]	杨孜. 妊娠期高血压疾病诊治新观点——谈诊治概念与理念之碰撞[J]. 实用妇产科杂志, 2021, 37(3):168-171.
[15]	Webster K, Fishburn S, Maresh M, et al. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance[J]. BMJ, 2019,366:l5119. doi: 10.1136/bmj.l5119.
[16]	Magee LA, Smith GN, Bloch C, et al. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management[J]. J Obstet Gynaecol Can, 2022, 44(5):547-571.e1. doi: 10.1016/j.jogc.2022.03.002. pmid: 35577426
[17]	Mone F, Mulcahy C, McParland P, et al. Should we recommend universal aspirin for all pregnant women?[J]. Am J Obstet Gynecol, 2017, 216(2):141.e1-e5. doi: 10.1016/j.ajog.2016.09.086.
[18]	MacDonald TM, Walker SP, Hannan NJ, et al. Clinical tools and biomarkers to predict preeclampsia[J]. EBioMedicine, 2022,75:103780. doi: 10.1016/j.ebiom.2021.103780.
[19]	赫英东, 陈倩. 阿司匹林预防子痫前期的局限性和临床应用选择[J]. 中国实用妇科与产科杂志, 2021, 37(5):519-522. doi: 10.19538/j.fk2021050104.
[20]	Lin L, Huai J, Li B, et al. A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China[J]. Am J Obstet Gynecol, 2022, 226(2):251.e1-e12. doi: 10.1016/j.ajog.2021.08.004.
[21]	Chaemsaithong P, Cuenca-Gomez D, Plana MN, et al. Does low-dose aspirin initiated before 11 weeks′ gestation reduce the rate of preeclampsia?[J]. Am J Obstet Gynecol, 2020, 222(5):437-450. doi: 10.1016/j.ajog.2019.08.047. pmid: 31494125
[22]	Meher S, Duley L, Hunter K, et al. Antiplatelet therapy before or after 16 weeks′ gestation for preventing preeclampsia: an individual participant data meta-analysis[J]. Am J Obstet Gynecol, 2017, 216(2):121-128.e2. doi: 10.1016/j.ajog.2016.10.016.
[23]	傅勤, 陈昕华, 林建华. 重度子痫前期史患者低剂量阿司匹林预防用药的再次妊娠结局分析[J]. 实用妇产科杂志, 2020, 36(10):752-756.
[24]	Rolnik DL, Wright D, Poon L, et al. ASPRE trial: performance of screening for preterm pre-eclampsia[J]. Ultrasound Obstet Gynecol, 2017, 50(4):492-495. doi: 10.1002/uog.18816. pmid: 28741785
[25]	Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis[J]. Am J Obstet Gynecol, 2018, 218(3):287-293.e1. doi: 10.1016/j.ajog.2017.11.561. pmid: 29138036
[26]	Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia[J]. N Engl J Med, 2017, 377(7):613-622. doi: 10.1056/NEJMoa1704559.
[27]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018:83-90.
[28]	Roberge S, Nicolaides K, Demers S, et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2017, 216(2):110-120.e6. doi: 10.1016/j.ajog.2016.09.076. pmid: 27640943
[29]	Duley L, Meher S, Hunter KE, et al. Antiplatelet agents for preventing pre-eclampsia and its complications[J]. Cochrane Database Syst Rev, 2019, 2019(10):CD004659. doi: 10.1002/14651858.CD004659.pub3.
[30]	Ghesquiere L, Guerby P, Marchant I, et al. Comparing aspirin 75 to 81 mg vs 150 to 162 mg for prevention of preterm preeclampsia: systematic review and meta-analysis[J]. Am J Obstet Gynecol MFM, 2023, 5(7):101000. doi: 10.1016/j.ajogmf.2023.101000.
[31]	Espinoza J. Low-Dose Aspirin for the Prevention of Preeclampsia[J]. JAMA, 2021, 326(12):1153-1155. doi: 10.1001/jama.2021.14646. pmid: 34581753
[32]	Gu W, Lin J, Hou YY, et al. Effects of low-dose aspirin on the prevention of preeclampsia and pregnancy outcomes: A randomized controlled trial from Shanghai, China[J]. Eur J Obstet Gynecol Reprod Biol, 2020, 248:156-163. doi: 10.1016/j.ejogrb.2020.03.038. pmid: 32217429
[33]	张英红, 刘国莉. 小剂量阿司匹林在子痫前期预防中的应用及管理[J]. 中华围产医学杂志, 2017, 20(4):241-243. doi: 10.3760/cma.j.issn.1007-9408.2017.04.001.
[34]	杨藻宸. 医用药理学[M]. 4版. 北京: 人民卫生出版社, 2005:332-333.
[35]	Ayala DE, Ucieda R, Hermida RC. Chronotherapy with low-dose aspirin for prevention of complications in pregnancy[J]. Chronobiol Int, 2013, 30(1/2):260-279. doi: 10.3109/07420528.2012.717455.
[36]	Wright D, Poon LC, Rolnik DL, et al. Aspirin for Evidence-Based Preeclampsia Prevention trial: influence of compliance on beneficial effect of aspirin in prevention of preterm preeclampsia[J]. Am J Obstet Gynecol, 2017, 217(6):685.e1-e5. doi: 10.1016/j.ajog.2017.08.110.
[37]	Navaratnam K, Alfirevic A, Jorgensen A, et al. Aspirin non-responsiveness in pregnant women at high-risk of pre-eclampsia[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 221:144-150. doi: 10.1016/j.ejogrb.2017.12.052. pmid: 29304392