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中国系统性红斑狼疮(SLE)患者的妊娠结局:109例妊娠的回顾性研究

Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies.

作者信息

Ku Ming, Guo Shuiming, Shang Weifeng, Li Qing, Zeng Rui, Han Min, Ge Shuwang, Xu Gang

机构信息

Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

出版信息

PLoS One. 2016 Jul 21;11(7):e0159364. doi: 10.1371/journal.pone.0159364. eCollection 2016.

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women during their reproductive years. The interaction between SLE and pregnancy remains debated. The objective of this study was to analyze the fetal and maternal outcomes of Chinese women with SLE. A total of 109 pregnancies in 83 SLE patients from June 2004 to June 2014 at a tertiary university hospital were reviewed retrospectively. Patients' characteristics, clinical and laboratory data during pregnancy were obtained from electronic medical records. After exclusion of elective abortions, the live birth rate was 61.5%. Significantly, APS (antiphospholipid syndrome), disease activity, hypertension, hypocomplementemia, thrombocytopenia, and anemia during pregnancy were more commonly observed in fetal loss pregnancies than in live birth pregnancies. Compared to the 64 women with a history of SLE, 19 women with new-onset lupus during pregnancy had worse pregnancy outcome. Furthermore, the 64 patients with a history of SLE were divided into lupus nephritis group and SLE group (non-renal involvement). We found that the lupus nephritis group had worse maternal outcome than the SLE group. We conclude that new-onset lupus during pregnancy predicts both adverse maternal and fetal outcomes, while a history of lupus nephritis predicts adverse maternal outcomes. It is essential to provide SLE women with progestational counseling and regular multispecialty care during pregnancy.

摘要

系统性红斑狼疮(SLE)是一种多系统自身免疫性疾病,主要影响处于生育年龄的女性。SLE与妊娠之间的相互作用仍存在争议。本研究的目的是分析中国SLE女性患者的胎儿和母亲结局。回顾性分析了2004年6月至2014年6月在一所三级大学医院的83例SLE患者中的109次妊娠情况。从电子病历中获取患者的特征、孕期的临床和实验室数据。排除选择性流产后,活产率为61.5%。值得注意的是,与活产妊娠相比,胎儿丢失妊娠中更常见抗磷脂综合征(APS)、疾病活动、高血压、低补体血症、血小板减少症和贫血。与64例有SLE病史的女性相比,19例孕期新发狼疮的女性妊娠结局更差。此外,将64例有SLE病史的患者分为狼疮肾炎组和SLE组(无肾脏受累)。我们发现狼疮肾炎组的母亲结局比SLE组更差。我们得出结论,孕期新发狼疮预示着母亲和胎儿的不良结局,而狼疮肾炎病史预示着母亲的不良结局。在孕期为SLE女性提供孕激素咨询和定期多专科护理至关重要。

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