Kiss Emese, Kiss Csaba György, Poór Gyula
Országos Reumatológiai és Fizioterápiás Intézet, Budapest.
Orv Hetil. 2011 Oct 23;152(43):1715-23. doi: 10.1556/OH.2011.29216.
The coincidence of systemic autoimmune diseases and pregnancy may modify the outcome of the disease and the pregnancy due to the background immunologic and hormonal processes. The great majority of patients with autoimmune diseases are young females in their reproductive years, willing to have babies. Consequently, we have to prepare for this special situation. Our concept on childbearing in autoimmune women has changed within the last 30 years. Earlier, systemic lupus erythematosus flared in about 50% of patients during pregnancy, but the flare rate has significantly decreased recently. This improvement can be attributed to increased attention to low diseases activity at the time of conception, which might reduce to the half of the risk for flare. Tight control of patients and appropriate use of corticosteroids also contribute to the better results. The adequate use of anti-thrombotic agents resulted in a significant amelioration of pregnancy outcome in antiphospholipid syndrome. The earlier use of methotrexate and the introduction of tumor necrosis factor-alpha inhibitors in the treatment of rheumatoid arthritis have changed the natural characteristics of the disease. The increase in remission rate indirectly has beneficial effect on the number of planned and carried out pregnancies. Authors review the connection between systemic autoimmune disorders and pregnancy as well as the possibilities of medical treatment of such diseases during pregnancy.
由于免疫和激素背景过程，系统性自身免疫性疾病与妊娠的并存可能会改变疾病和妊娠的结局。绝大多数自身免疫性疾病患者是处于生育年龄的年轻女性，她们希望生育子女。因此，我们必须为这种特殊情况做好准备。在过去30年里，我们对自身免疫性疾病女性生育的观念发生了变化。早些时候，约50%的系统性红斑狼疮患者在孕期病情会复发，但最近复发率已显著下降。这种改善可归因于受孕时对低疾病活动度的关注度增加，这可能会将复发风险减半。对患者的严格管理和皮质类固醇的合理使用也有助于取得更好的效果。抗血栓药物的合理使用显著改善了抗磷脂综合征的妊娠结局。甲氨蝶呤的早期使用以及肿瘤坏死因子-α抑制剂在类风湿关节炎治疗中的引入改变了该疾病的自然病程。缓解率的提高间接对计划内和已实施妊娠的数量产生了有益影响。作者回顾了系统性自身免疫性疾病与妊娠之间的联系以及孕期此类疾病的药物治疗可能性。
