Mecacci Federico, Pieralli Annalisa, Bianchi Barbara, Paidas Michael J
Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
Semin Perinatol. 2007 Aug;31(4):223-6. doi: 10.1053/j.semperi.2007.05.005.
Autoimmune diseases are a group of heterogeneous disorders equally characterized by the same pathogenetic mechanism: an immunological reaction against self antigens promoted by antibodies, immuno-complex formation, and self-reactive T lymphocytes. Autoimmune diseases may be separated into organ-restricted diseases and systemic ones. The damage of single organs produced by antibodies focused against specific cellular antigens characterizes the first group of diseases, whereas the latter are produced by a systemic inflammatory process initiated by inappropriate and excess immune activation that leads to immuno-complex formation and deposition onto sensitive tissues. Since connective and vascular tissue are principally damaged in these disorders, systemic autoimmune diseases are more commonly known as "connective tissue diseases" (CTD) and include: systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, Sjogren syndrome, and others. Although they are considered as different from a pathogenetic point of view, they overlap in many aspects, such as general symptoms as fever and fatigue, chronical ongoing, steroid therapy. As patients suffering from CTD are predominantly young women between the ages of 20 and 40 years, which is the period of the highest childbearing potential, particular interest must be regarded to the impact that these diseases and their therapies have on pregnancy and, conversely, the effect of pregnancy on these disorders, which may have long-lasting implications for mothers and neonates. Adverse fetal outcomes, maternal disease flares, and drug potential teratogenic risk are the main reasons why women suffering from CTD and who are pregnant or intend to become pregnant are considered a high-risk population. These patients require integrated, interdisciplinary care, addressing every aspect of rheumatology, obstetrics, and neonatology to reduce maternal, fetal, and neonatal complications.
自身免疫性疾病是一组异质性疾病，具有相同的发病机制：由抗体、免疫复合物形成和自身反应性T淋巴细胞引发的针对自身抗原的免疫反应。自身免疫性疾病可分为器官局限性疾病和全身性疾病。针对特定细胞抗原的抗体对单个器官造成的损害是第一类疾病的特征，而后者则是由不适当和过度的免疫激活引发的全身性炎症过程所致，这种免疫激活会导致免疫复合物形成并沉积在敏感组织上。由于结缔组织和血管组织在这些疾病中主要受到损害，全身性自身免疫性疾病通常被称为“结缔组织病”（CTD），包括：系统性红斑狼疮、类风湿性关节炎、系统性硬化症、干燥综合征等。尽管从发病机制的角度来看它们被认为是不同的，但它们在许多方面存在重叠，如发热和疲劳等一般症状、病程持续、类固醇治疗等。由于患有结缔组织病的患者主要是年龄在20至40岁之间的年轻女性，这是生育潜力最高的时期，因此必须特别关注这些疾病及其治疗方法对妊娠的影响，反之，妊娠对这些疾病的影响，这可能对母亲和新生儿产生长期影响。不良的胎儿结局、母体疾病复发以及药物潜在的致畸风险是患有结缔组织病且怀孕或打算怀孕的女性被视为高危人群的主要原因。这些患者需要综合的、跨学科的护理，涉及风湿病学、产科学和新生儿学的各个方面，以减少母体、胎儿和新生儿的并发症。
