Rubbert A, Pirner K, Wildt L, Kalden J R, Manger B
Department of Medicine III, University of Erlangen-Nurnberg, Germany.
Am J Reprod Immunol. 1992 Oct-Dec;28(3-4):205-7. doi: 10.1111/j.1600-0897.1992.tb00792.x.
Among 165 patients with systemic lupus erythematosus (SLE), we observed 21 pregnancies in 19 patients since 1987. The mean duration of disease at the time of pregnancy was 4.5 +/- 3 years. All but three patients required immunosuppressive treatment before and during pregnancy. The effect of pregnancy on the course of SLE was studied. Severe disease exacerbations were rare and largely confined to patients with renal involvement. Most patients showed elevated titers of dsDNA antibodies during pregnancy but clinical activity of disease was usually mild. Complement C3 decrease appeared to be the most sensitive marker for pregnancy-related complications. The detection of antibodies to phospholipids was frequent during pregnancy in contrast to a low prevalence before and after pregnancy. Their presence could be associated with intrauterine growth retardation. Preterm delivery before the 37th week of pregnancy had to be performed in the majority of patients. None of the patients experienced abortion although three patients had to delivered in the 29th week of pregnancy because of increasing symptoms of pre-eclampsia. Two of these children died and the third child suffered from intracranial hemorrhage in the early postpartum period. Our data demonstrate that successful pregnancy outcome was related to a gestational age of more than 32 weeks, making careful monitoring and appropriate therapeutic management necessary.
自1987年以来，在165例系统性红斑狼疮（SLE）患者中，我们观察到19例患者中有21次妊娠。妊娠时的平均病程为4.5±3年。除3例患者外，所有患者在妊娠前和妊娠期间均需要免疫抑制治疗。研究了妊娠对SLE病程的影响。严重疾病加重很少见，主要局限于有肾脏受累的患者。大多数患者在妊娠期间双链DNA抗体滴度升高，但疾病的临床活动通常较轻。补体C3降低似乎是与妊娠相关并发症最敏感的标志物。与妊娠前后低患病率相比，妊娠期间抗磷脂抗体的检测很常见。它们的存在可能与宫内生长迟缓有关。大多数患者必须在妊娠37周前早产。尽管有3例患者因先兆子痫症状加重而不得不在妊娠29周分娩，但没有患者发生流产。其中2名儿童死亡，第3名儿童在产后早期患有颅内出血。我们的数据表明，成功的妊娠结局与孕周超过32周有关，因此需要仔细监测和适当的治疗管理。
