Webster P, Wardle A, Bramham K, Webster L, Nelson-Piercy C, Lightstone L
Imperial College Healthcare NHS Trust Lupus Centre, Hammersmith Hospital, London, UK
Imperial College Healthcare NHS Trust Lupus Centre, Hammersmith Hospital, London, UK.
Lupus. 2014 Oct;23(11):1192-6. doi: 10.1177/0961203314540353. Epub 2014 Jun 13.
Lupus nephritis during pregnancy increases morbidity and mortality for mother and baby. Flares are difficult to treat as many therapeutic options are teratogenic or fetotoxic. Steroids alone may be unable to control disease activity and are associated with higher rates of preterm delivery, sepsis and gestational diabetes. Reports of using tacrolimus to treat lupus nephritis in pregnancy are limited. We describe the pregnancies of nine women in whom tacrolimus was successfully used to treat lupus nephritis flare (six patients) or maintain stable disease (three patients). Introduction or dose escalation of oral steroids was avoided in five of the patients who developed active disease and steroid dose was rapidly reduced in the sixth patient. All women with disease flare attained partial or complete remission after starting tacrolimus. None of the women on maintenance treatment developed active disease. We propose tacrolimus as an effective adjuvant or alternative therapy to steroids for treating lupus nephritis flare or maintaining stable disease during pregnancy.
妊娠期间的狼疮性肾炎会增加母婴的发病率和死亡率。由于许多治疗选择具有致畸性或对胎儿有毒性，因此病情发作难以治疗。仅使用类固醇可能无法控制疾病活动，且与早产、败血症和妊娠期糖尿病的发生率较高有关。关于使用他克莫司治疗妊娠期间狼疮性肾炎的报道有限。我们描述了9名女性的妊娠情况，她们使用他克莫司成功治疗了狼疮性肾炎发作（6例患者）或维持疾病稳定（3例患者）。5例出现活动性疾病的患者避免了口服类固醇的引入或剂量增加，第6例患者的类固醇剂量迅速降低。所有疾病发作的女性在开始使用他克莫司后均实现了部分或完全缓解。接受维持治疗的女性均未出现活动性疾病。我们建议将他克莫司作为类固醇的有效辅助或替代疗法，用于治疗妊娠期间的狼疮性肾炎发作或维持疾病稳定。
