CAJ | 학술논문

目的总结系统性红斑狼疮(SEE)合并妊娠的母婴结局,分析妊娠期问SLE病情恶化、胎儿丢失、不良胎儿结局的预测因素.方法回顾性分析1990年1月至2007年12月在北京协和医院和深圳市人民医院住院的SEE合并妊娠临床资料.结果 120例SEE合并妊娠145例次,妊娠时年龄18～4I岁,平均(28±4)岁,SEE病程0.5～18年,平均(5±4)年.共有46例次(31.7%)妊娠期间SLE病情恶化,主要在妊娠中、晚期,常累及皮肤黏膜及关节肌肉系统.妊娠期间SEE病情恶化与妊娠前病情活动及低补体血症有关(P＜0.05).妊娠前病情活动组子痫前期及子痫的发生率明显高于病情稳定组(P＜0.01).共成功分娩104例次(71.7%,其中双胞胎2例),18例次自然流产(12.4%),10例次死产(6.9%),13例次治疗性流产(9.0%).早产36例次(34.6%),新生儿出现宫内生长迟缓(IUGR)37例次(35.6%).胎儿丢失(包括自然流产及死产)的危险因素有合并抗磷脂综合征(APS)、妊娠前病情活动(P＜0.05);引起不良胎儿结局(包括早产或IUGR)的危险因素有妊娠前抗dsDNA抗体阳性、泼尼松剂量≥10 mg/d及妊娠期间SLE病情恶化(P＜0.05).21例患者行胎盘病理学检查,其中13例发现胎盘组织血管壁纤维素样坏死、梗死表现,该组患者抗磷脂抗体阳性率明显高于胎盘病理基本健康组(P＜0.05).结论妊娠前SEE病情活动、低补体血症与SEE妊娠期间SEE病情恶化相关.合并APS、妊娠前病情活动使胎儿丢失的危险性增加,而妊娠前抗dsDNA抗体阳性、泼尼松剂量≥10 mg/d及妊娠期间SLE病情恶化使不良胎儿结局的危险性增加.
목적 총결계통성홍반랑창(SEE)합병임신적모영결국,분석임신기문SLE병정악화、태인주실、불량태인결국적예측인소.방법 회고성분석1990년1월지2007년12월재북경협화의원화심수시인민의원주원적SEE합병임신림상자료.결과 120례SEE합병임신145례차,임신시년령18～4I세,평균(28±4)세,SEE병정0.5～18년,평균(5±4)년.공유46례차(31.7%)임신기간SLE병정악화,주요재임신중、만기,상루급피부점막급관절기육계통.임신기간SEE병정악화여임신전병정활동급저보체혈증유관(P＜0.05).임신전병정활동조자간전기급자간적발생솔명현고우병정은정조(P＜0.01).공성공분면104례차(71.7%,기중쌍포태2례),18례차자연유산(12.4%),10례차사산(6.9%),13례차치료성유산(9.0%).조산36례차(34.6%),신생인출현궁내생장지완(IUGR)37례차(35.6%).태인주실(포괄자연유산급사산)적위험인소유합병항린지종합정(APS)、임신전병정활동(P＜0.05);인기불량태인결국(포괄조산혹IUGR)적위험인소유임신전항dsDNA항체양성、발니송제량≥10 mg/d급임신기간SLE병정악화(P＜0.05).21례환자행태반병이학검사,기중13례발현태반조직혈관벽섬유소양배사、경사표현,해조환자항린지항체양성솔명현고우태반병리기본건강조(P＜0.05).결론 임신전SEE병정활동、저보체혈증여SEE임신기간SEE병정악화상관.합병APS、임신전병정활동사태인주실적위험성증가,이임신전항dsDNA항체양성、발니송제량≥10 mg/d급임신기간SLE병정악화사불량태인결국적위험성증가.
Objective To summarize the maternal and fetal outcomes of pregnancies of patients with systemic lupus erythematosus (SLE) and to evaluate the clinical predictors of SLE exacerbations,fetal loss and poor fetal outcome.MethodsOne hundred and forty five pregnancies in 120 SLE patients treated between January 1990 and December 2007 in Peking Union Medical College Hospital and Shenzhen People's Hospital were investigated retrospectively.Results One hundred and twenty cases of SLE patients had 145 pregnancies in total,their gestational age was 18 to 41 (282±4) years old and the duration of SLE was (5±4) years (0.5 to 18 years).SLE exacerbation occurred in 46 pregnancies (31.7%),mostly in the second and third trimester of pregnancy.The mucocutaneous and musculoskeletal system involvement were common.SLE exacerbation during pregnancy was related to the SLE disease activity and hypocomplementemia before pregnancy (P＜0.05).The frequency of pre-eclampsia and eclampsia in patients whose SLE was active before pregnancy was significantly higher than those whose lupus was stable before pregnancy(P＜0.01).There were 104 cases of successful delivery (71.7%,2 twin birth),18 cases of spontaneous abortion (12.4%),10 cases of stillbirth (6.9%) and 13 cases of therapeutic abortion (9.0%).Of the live-born infant births,36 cases were premature (34.6%),37 had suffered intrauterine growth retardation (IUGR) (35.6%).The predictors of fetal loss (including spontaneous abortion and stillbirth) included antiphospholipid syndrome (APS) and active SLE before pregnancy (P＜0.05).The predictors of poor fetal outcome (including prematurity or IUGR) included positive anti-dsDNA antibodies,≥10 mg/d dosage of prednisone prior to pregnancy and SLE exacerbation during pregnancy (P＜0.05).Of the 21 placenta examined pathologically,the typical fibrinoid vascular necrosis and vascular infarction was found in 13 placentas.The percentage of positive antiphos-pholipid antibody in patients with typical fibrinoid vascular necrosis and vascular infarction in their placentas was significantly higher than those with normal placentas (P＜0.05).ConclusionThe active SLE and hypocomplementemia before pregnancy in patients with SLE are associated with SLE exacerbation during pregnancy.The combined APS and active SLE before pregnancy increases the risk of fetal loss,while positive anti-dsDNA antibody,≥10 mg/d dosage of prednisone before pregnancy and SLE exacerbation during pregnancy increase the risk of poor fetal outcome.