Division of Rheumatology, Duke University Medical Center, Durham, North Carolina, USA.
J Rheumatol. 2011 Jun;38(6):1012-6. doi: 10.3899/jrheum.100746. Epub 2011 Mar 16.
The importance of low complement and anti-dsDNA during pregnancy in patients with systemic lupus erythematosus (SLE) is poorly defined. We investigated the effect of these laboratory tests and clinical SLE activity on pregnancy outcomes.
We conducted a study of all pregnancies in patients with SLE followed from 1986 to 2002 in a cohort of patients with SLE. At each visit, the physician's estimate of activity (PEA), complement, and anti-dsDNA antibody were measured. We assessed the combination of moderate to severe SLE clinical activity (defined as PEA ≥ 2) and these serologic measurements on pregnancy outcomes. Pregnancies electively terminated were excluded from our study.
Regardless of SLE activity, low complement or positive anti-dsDNA in the second trimester was associated with a higher rate of pregnancy loss and preterm birth. Patients with the combination of either high clinical activity of SLE and low complement or positive anti-dsDNA had the highest rate of pregnancy loss and preterm birth.
Women with the combination of high clinical activity with serologic markers of SLE activity are at highest risk for pregnancy loss and preterm delivery. While hypocomplementemia and positive anti-dsDNA alone are predictive of poor pregnancy outcomes in the second trimester, the risks are far higher for the women in whom this is coupled with clinically active SLE.
系统性红斑狼疮（SLE）患者妊娠期间补体水平低和抗双链 DNA（dsDNA）抗体阳性的重要性尚未明确。本研究旨在探讨这些实验室检查和临床 SLE 活动对妊娠结局的影响。
我们对 1986 年至 2002 年间在一组 SLE 患者中随访的所有 SLE 患者妊娠进行了研究。每次就诊时，均测量医生评估的活动度（PEA）、补体和抗 dsDNA 抗体。我们评估了中度至重度 SLE 临床活动（定义为 PEA≥2）与这些血清学指标对妊娠结局的联合影响。我们排除了选择性终止妊娠的病例。
无论 SLE 活动度如何，妊娠中期补体水平低或抗 dsDNA 抗体阳性与较高的流产率和早产率相关。同时存在 SLE 临床活动度高和补体水平低或抗 dsDNA 抗体阳性的患者，流产率和早产率最高。
具有 SLE 活动的临床和血清学标志物的女性发生流产和早产的风险最高。虽然单纯低补体血症和抗 dsDNA 抗体阳性在妊娠中期预示着不良妊娠结局，但在与临床活动 SLE 相关的情况下，风险更高。
