简报：使用瑞典人群登记处研究系统性红斑狼疮生育妇女的妊娠结局与心血管原因死亡的相关性。
Brief Report: Association Between Pregnancy Outcomes and Death From Cardiovascular Causes in Parous Women With Systemic Lupus Erythematosus: A Study Using Swedish Population Registries.
机构信息
Women's Health Academic Centre, King's College London, and King's Health Partners, London, UK, and University of Auckland and National Women's Health, Auckland, New Zealand (current address: John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK, and Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK).
Women's Health Academic Centre, King's College London, and King's Health Partners, London, UK.
出版信息
Arthritis Rheumatol. 2015 Sep;67(9):2376-82. doi: 10.1002/art.39218.
OBJECTIVE
To determine if maternal placental syndromes (MPS) are associated with an increased risk of death from cardiovascular causes in women with systemic lupus erythematosus (SLE).
METHODS
Between 1973 and 2011, women with SLE and a history of pregnancy were identified using linked Swedish population registries. The outcome was death from primarily cardiovascular causes, defined as death from acute coronary syndrome or coronary artery disease, stroke, or peripheral vascular disease. The exposure was MPS, defined as any hypertensive disorders in pregnancy, stillbirth, placental abruption, or delivery of a small-for-gestational-age infant. The association of preterm delivery (delivery at <34 weeks of gestation) with death from cardiovascular causes was also explored. Risk of death from cardiovascular causes was determined using logistic regression, adjusting for the year of first delivery, duration of SLE, number of inpatient admissions, and cardiovascular risk factors.
RESULTS
A total of 3,977 women with SLE had 7,410 pregnancies during the study interval. Death from primarily cardiovascular causes occurred in 44 of the 325 women who died (13.5%). The median age at death from cardiovascular causes was 54 years (interquartile range 48-58 years), and these women were more likely to have had hypertension and renal disease. MPS was associated with an increased risk of death from primarily cardiovascular causes (adjusted odds ratio [OR] 2.19 [95% confidence interval (95% CI) 1.14-4.22]), specifically, a history of placental abruption (adjusted OR 5.78 [95% CI 1.61-20.72]). Delivery at <34 weeks of gestation, particularly when combined with MPS, was also associated with an increased risk of death from primarily cardiovascular causes (adjusted OR 2.49 [95% CI 1.06-5.85]).
CONCLUSION
MPS in pregnancy is associated with a higher risk of death from primarily cardiovascular causes in women with SLE.
目的
确定母体胎盘综合征（MPS）是否与系统性红斑狼疮（SLE）女性心血管原因死亡风险增加相关。
方法
1973 年至 2011 年间，使用瑞典人口登记册确定了患有 SLE 且有妊娠史的女性。结局为主要心血管原因导致的死亡，定义为急性冠状动脉综合征或冠状动脉疾病、中风或外周血管疾病导致的死亡。暴露因素为 MPS，定义为任何妊娠高血压疾病、死胎、胎盘早剥或小于胎龄儿的分娩。还探讨了早产（<34 周分娩）与心血管原因死亡的关系。使用逻辑回归确定心血管原因死亡的风险，调整首次分娩年份、SLE 持续时间、住院次数和心血管危险因素。
结果
共有 3977 名患有 SLE 的女性在研究期间进行了 7410 次妊娠。325 名死亡患者中有 44 名（13.5%）死于心血管原因。心血管原因死亡的中位年龄为 54 岁（四分位间距 48-58 岁），这些患者更可能患有高血压和肾脏疾病。MPS 与主要心血管原因死亡风险增加相关（调整后的优势比[OR]2.19[95%置信区间（95%CI）1.14-4.22]），特别是胎盘早剥史（调整后的 OR 5.78[95%CI 1.61-20.72]）。<34 周分娩，尤其是与 MPS 合并时，也与主要心血管原因死亡风险增加相关（调整后的 OR 2.49[95%CI 1.06-5.85]）。
结论
妊娠期间的 MPS 与 SLE 女性主要心血管原因死亡风险增加相关。
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