抗磷脂質症候群與懷孕

               早在80年代就已經提出抗磷脂質症候群可能影響懷孕初期，有研究提出抗磷脂質症候群(以下簡稱aPL)與不孕有關[39]。自此，許多學者認為aPL可能會干擾蛻膜形成(decidualization)進而影響著床。但是不孕並沒有被納入抗磷脂質症候群的診斷標準中[40]，不過仍有許多醫師會為不孕的女性檢查aPL，儘管現行的治療仍缺少實證醫學的支持，只要檢測結果屬於陽性，大多數生殖中心仍會在進行IVF的同時施予治療。

            有研究團隊蒐集1988-2013的研究，試圖釐清不孕症女性與正常女性aPL檢出陽性率是否有差異：

從篩                 選出的29篇研究中[41–68]，不孕症被分為兩大類，一類是找不出原因的不孕，準備接受第一次IVF；另一類是曾經IVF失敗。29篇研究中有13篇(44.8%)認為相較於正常女性，不孕症女性明顯有較高的機會驗出aPL。[41–45,48–51,59,62,65,69]然而這些研究中僅有2篇是完全檢測三項aPL[65,70]，每篇研究都有檢測aCL，但只有5篇研究有檢測LA[41,44,49,50,65]，僅2篇檢測β2GPI[65,70]，同時只有2篇研究有依照診斷標準於6-12週後再次檢測確認aPL為陽性。[43,65]

              由於這些研究內容的差異難以進行統合分析(Meta-analysis)，目前仍有待更多研究來確立aPL在生殖困境上扮演的角色。

              總結許多研究發現進行IVF時aPL陽性率較高，這可能是伴隨荷爾蒙治療出現的一種現象。2000年有一篇metanalysis的研究指出對於IVF的懷孕率及活產率，在有無aPL 的身上並沒有太大差異，因此認為aPL並不會降低IVF的成功率。

               抗磷脂質症候群主要以血栓作為臨床表現，發病需要的條件包含血管內皮細胞的損傷及氧化壓力，血管內皮細胞損傷依據中醫「心主血脈」的生理特性，主要病位應在於「心」，凡是影響心氣推動血脈的因素皆有可能導致「瘀」的形成，且發病的層次常犯及「血分」；氧化壓力依據「少火生氣，壯火食氣」，可知在正常有度的氧化下可提供人體所需的能量，但異常失序的氧化壓力則反而造成身體的負擔。從上述兩點分析可得知病位在「心」，病性屬「火」，然而由於火邪具有「耗氣傷津」的特點，因此在不同病程中患者的虛實表現不一，難以一概而論。

談到「壯火」，其形成可因內在臟腑失調，也可因為外界六淫侵襲所導致，內在臟腑常見心肝火旺或腎水不足；凡有外感病邪鬱遏於體表皆可能熱，尤其是溫邪具有容易化熱、化燥、犯及血分的特點。臨床上常見患者表示自己不易出汗、睡臥不安或長期咽喉不適，治療上必須思考三大主軸，首重解散表邪，使「上焦得通，津液得下，胃氣因和，身濈然汗出而解」，其次為調和五臟，使水道、脈道通暢，其三若患者因療程時間緊迫，即將胚胎植入，急者治其標先從「血熱」治之並配合辛涼解表藥先制其熱勢，常使用牡丹皮、生地、赤芍再配合連翹、薄荷葉、蟬蛻等藥。張錫純認為阿斯匹靈「味酸性涼，最善達表，使內鬱之熱由表解散」，目前西醫採用阿斯匹靈作為抗磷脂症症候群的首選藥物，也正切合中醫觀察到的內鬱之熱。

               有研究提出不同表現的抗磷脂質症候群，背後的致病機轉可能不同，對於是否會直接造成不孕、重複性流產、早產、子癲前症或胎盤功能不良目前仍沒有定論，但這部分產科併發症的背後，按臨床所見極有可能屬於火邪「耗氣傷津」導致的虛性病程，往往帶有火熱之標象，然而實際上心脾腎極虛，治療上不能盲目遵從免疫疾病不宜用補的概論，需分段施治，才能增加活產率。

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