Silva Clovis A A, Hilario Maria O, Febronio Marilia V, Oliveira Sheila K, Almeida Rozana G, Fonseca Adriana R, Yamashita Edson M, Ronchezel Marcos V, Campos Luciene L, Appenzeller Simone, Quintero Maria V, Santos Ana B, Medeiros Ana C, Carvalho Luciana M, Robazzi Teresa C, Cardin Silvana P, Bonfa Eloisa
Paediatric Rheumatology Units of the University of São Paulo, Federal University of São Paulo, Federal University of Rio de Janeiro, Santa Casa of São Paulo, Brazil.
J Rheumatol. 2008 Jul;35(7):1414-8. Epub 2008 Apr 1.
To determine pregnancy outcome and fetal loss risk factors in patients with juvenile systemic lupus erythematosus (JSLE).
A total of 315 female patients with JSLE followed in 12 Brazilian pediatric rheumatology centers were consecutively selected. Menarche was observed in 298 (94.6%) patients. Patients' medical records were reviewed for pregnancy outcomes and demographic, clinical, and therapeutic data.
A total of 24 unplanned pregnancies occurred in 298 (8%) patients. The outcomes were 5 (21%) early fetal losses (prior to 16 wks gestation), 18 (75%) live births, and 1 (4%) death due to preeclampsia and premature birth. The frequencies of active diffuse proliferative glomerulonephritis, proteinuria > or = 0.5 g/day, and arterial hypertension at the beginning of pregnancy were higher in pregnancies resulting in fetal losses than in live births [60% vs 5% (p = 0.02), 60% vs 5% (p = 0.02), 60% vs 5% (p = 0.02), respectively]. JSLE pregnancies with fetal losses had a significantly higher mean SLE Disease Activity Index 2000 (SLEDAI-2K) at the start of pregnancy compared with those with live births (9.40 +/- 7.47 vs 3.94 +/- 6.00; p = 0.049). Four pregnancies were inadvertently exposed to intravenous cyclophosphamide therapy for renal involvement despite contraceptive prescriptions, resulting in fetal loss in 3 (p = 0.02). In multivariate analysis only intravenous cyclophosphamide use at start of pregnancy (OR 25.50, 95% CI 1.72-377.93, p = 0.019) remained as an independent risk factor for fetal loss.
We identified immunosuppressive therapy as the major contributing factor for fetal loss in JSLE, reinforcing the importance of contraception.
确定青少年系统性红斑狼疮（JSLE）患者的妊娠结局及胎儿丢失的危险因素。
连续选取巴西12个儿科风湿病中心随访的315例女性JSLE患者。298例（94.6%）患者出现月经初潮。查阅患者病历以获取妊娠结局以及人口统计学、临床和治疗数据。
298例（8%）患者共发生24次意外妊娠。结局为5例（21%）早期胎儿丢失（妊娠16周前），18例（75%）活产，1例（4%）因子痫前期和早产死亡。妊娠导致胎儿丢失者在妊娠开始时活动性弥漫性增殖性肾小球肾炎、蛋白尿≥0.5g/天和动脉高血压的发生率高于活产者[分别为60% 对5%（p = 0.02），60% 对5%（p = 0.02），60% 对5%（p = 0.02）]。与活产者相比，胎儿丢失的JSLE妊娠在妊娠开始时的平均系统性红斑狼疮疾病活动指数2000（SLEDAI - 2K）显著更高（9.40±7.47对3.94±6.00；p = 0.049）。尽管有避孕处方，4例妊娠因肾脏受累无意中接受了静脉环磷酰胺治疗，导致3例胎儿丢失（p = 0.02）。多因素分析显示，仅妊娠开始时使用静脉环磷酰胺（比值比25.50，95%可信区间1.72 - 377.93，p = 0.019）仍是胎儿丢失的独立危险因素。
我们确定免疫抑制治疗是JSLE胎儿丢失的主要促成因素，强化了避孕的重要性。
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