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[1例狼疮抗凝物阳性的系统性红斑狼疮孕妇并发宫内死胎、子痫及脑干血管损伤]

[A case of pregnant woman with lupus anticoagulant positive systemic lupus erythematosus complicated with intrauterine fetal death, eclampsia, and brainstem vascular damage].

作者信息

Ishizuka T, Suzuki K, Hara M, Nakajima S, Hirose T, Harigai M, Hidaka T, Kawaguchi S, Kawagoe M, Nakamura H

机构信息

First Department of Internal Medicine, National Defense Medical College, Saitama.

出版信息

Ryumachi. 1991 Apr;31(2):184-93.

PMID:1925797
Abstract

A 28-year-old female patient with SLE was found to have complications from intrauterine fetal death, eclampsia, and brainstem vascular damage during pregnancy. These symptoms were associated with lupus anticoagulant (LAC). An LAC positive SLE case with accompanying cerebrovascular disease and fetal loss at the same time has rarely been reported. The first brain CT scan revealed the presence of multiple middle pons infarction. Ten days after onset, a brain MRI showed the change into hemorrhagic infarction in the same region, suggesting disseminated intravascular coagulation (DIC) caused by severe obstetric complications. Although the severity of the brain damage implied poor prognosis, her symptoms were alleviated by intensive care with a large amount of steroid therapy and active rehabilitation. LAC-positive SLE patients are apt to encounter obstetric complications in pregnancy. Therefore they must be treated by medical specialists in cooperation with gynecologists. When they also have accompanying with cerebrovascular diseases, active therapy for SLE is necessary for a good prognosis.

摘要

一名28岁的系统性红斑狼疮(SLE)女性患者在怀孕期间出现了宫内胎儿死亡、子痫和脑干血管损伤等并发症。这些症状与狼疮抗凝物(LAC)有关。同时伴有脑血管疾病和胎儿丢失的LAC阳性SLE病例鲜有报道。首次脑部CT扫描显示脑桥中部存在多处梗死。发病十天后,脑部MRI显示同一区域转变为出血性梗死,提示严重产科并发症导致弥散性血管内凝血(DIC)。尽管脑损伤的严重程度预示预后不良,但通过大量类固醇治疗的重症监护和积极康复,她的症状得到了缓解。LAC阳性的SLE患者在怀孕期间容易出现产科并发症。因此,他们必须由医学专家与妇科医生合作进行治疗。当他们还伴有脑血管疾病时,积极治疗SLE对于良好的预后是必要的。

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