37例系统性红斑狼疮或抗磷脂综合征患者的受精情况：97例手术系列研究
Fertilization in 37 Women with Systemic Lupus Erythematosus or Antiphospholipid Syndrome: A Series of 97 Procedures.
作者信息
Orquevaux Pauline, Masseau Agathe, Le Guern Véronique, Gayet Vanessa, Vauthier Danièle, Guettrot-Imbert Gaelle, Huong Du Le Thi, Wechsler Bertrand, Morel Nathalie, Cacoub Patrice, Pennaforte Jean-Loup, Piette Jean-Charles, Costedoat-Chalumeau Nathalie
机构信息
From the Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU), Reims Cedex; Service de médecine interne, CHU, Nantes; Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; Service de gynécologie-obstétrique, Hôpital Cochin, AP-HP; Service de gynécologie-obstétrique, Groupe Hospitalier Pitié Salpêtrière, AP-HP; Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B); INSERM, UMR_S 959, F-75013; CNRS, FRE3632, F-75005; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.
P. Orquevaux, MD, Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, CHU; A. Masseau, MD, Service de médecine interne, CHU; V. Le Guern, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; V. Gayet, MD, Service de gynécologie-obstétrique, Hôpital Cochin, AP-HP; D. Vauthier, MD, Service de gynécologie-obstétrique, Groupe Hospitalier Pitié Salpêtrière, AP-HP; G. Guettrot-Imbert, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; D.L. Huong, MD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; B. Wechsler, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; N. Morel, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; P. Cacoub, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; J.L. Pennaforte, MD, PhD, Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, CHU; J.C. Piette, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; N. Costedoat-Chalumeau, MD, PhD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP.
出版信息
J Rheumatol. 2017 May;44(5):613-618. doi: 10.3899/jrheum.160462. Epub 2017 Jan 15.
OBJECTIVE
To compile and assess data about complication and success rates for fertilization (IVF) of women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). To date, such data are sparse.
METHODS
This retrospective study described women with SLE and/or APS who have had at least 1 IVF cycle.
RESULTS
Thirty-seven women with SLE (n = 23, including 8 with antiphospholipid antibodies), SLE with APS (n = 4), or primary APS (n = 10) underwent 97 IVF procedures. For 43% of cases, the infertility was female in origin, for 19% male, 14% mixed, and 24% unexplained. No women had premature ovarian insufficiency because of cyclophosphamide. Median age at IVF was 34 years (range 26-46). The median number of IVF cycles was 2.6 (1-8). Patients were treated with hydroxychloroquine (72%), steroids (70%), azathioprine (3%), aspirin (92%), and/or low molecular weight heparin (62%). There were 27 (28%) pregnancies, 23 live births among 26 neonates (3 twin pregnancies), 2 miscarriages, and 2 terminations for trisomy 13 and 21. Six spontaneous pregnancies occurred during the followup. Finally, 26 women (70%) delivered at least 1 healthy child. Complications occurred in or after 8 IVF cycles (8%): SLE flares in 4 (polyarthritis in 3 and lupus enteritis in 1) and thromboembolic events in 4 others. One SLE flare was the first sign of previously undiagnosed SLE. Poor treatment adherence was obvious in 2 other flares and 2 thromboses. No ovarian hyperstimulation syndrome was reported.
CONCLUSION
These preliminary results confirm that IVF can be safely and successfully performed in women with SLE and/or APS.
目的
收集并评估系统性红斑狼疮（SLE）和/或抗磷脂综合征（APS）女性患者体外受精（IVF）的并发症及成功率数据。目前，此类数据较为稀少。
方法
这项回顾性研究描述了至少经历过1次IVF周期的SLE和/或APS女性患者。
结果
37例患有SLE（n = 23，其中8例伴有抗磷脂抗体）、SLE合并APS（n = 4）或原发性APS（n = 10）的女性患者接受了97次IVF手术。43%的病例不孕原因源于女性，19%源于男性，14%为混合性，24%原因不明。没有女性因环磷酰胺出现卵巢早衰。IVF时的中位年龄为34岁（范围26 - 46岁）。IVF周期的中位数为2.6（1 - 8）。患者接受了羟氯喹（72%）、类固醇（70%）、硫唑嘌呤（3%）、阿司匹林（92%）和/或低分子量肝素（62%）治疗。共有27例（28%）妊娠，26例新生儿中有23例活产（3例双胎妊娠），2例流产，2例因13三体和21三体而终止妊娠。随访期间发生了6例自然妊娠。最终，26名女性（70%）产下至少1名健康婴儿。8个IVF周期（8%）中或之后出现了并发症：4例出现SLE病情活动（3例为多关节炎，1例为狼疮性肠炎），另外4例出现血栓栓塞事件。1例SLE病情活动是先前未诊断出的SLE的首发症状。在另外2例病情活动和2例血栓形成中，治疗依从性差很明显。未报告卵巢过度刺激综合征。
结论
这些初步结果证实，SLE和/或APS女性患者可以安全、成功地进行IVF。
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