Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands.
Autoimmun Rev. 2017 Jul;16(7):701-711. doi: 10.1016/j.autrev.2017.05.005. Epub 2017 May 4.
To analyze published data on the influence of maternal systemic lupus erythematosus (SLE) on different aspects of child development.
A systematic review was conducted using PubMed and Embase searches for SLE or SLE-related antibodies and physical, neurocognitive, psychiatric or motor development outcomes in children.
In total 24 cohort and 4 case-control studies were included after initial screening of 1853 hits. Learning disorders (LD) were reported in 21.4-26% of SLE offspring, exceeding the prevalence in the general population. Four studies reported that dyslexia and reading problems were present in 14.3-21.6% of lupus offspring with a clear male predominance. Furthermore, a twofold increased rate of autism spectrum disorders (ASD) (n=1 study) and a two- to threefold increased risk for speech disorders (n=3 studies) were reported in lupus offspring compared to controls, although the latter was not statistically significant. More divergent results were found for attention deficit (n=5 studies) and behavior disorders (n=3 studies). In two large controlled studies attention disorders were more prevalent and a trend towards more behavior disorders was reported in 2 of 3 studies analyzing this subject. Finally, IQ and motor skills were not affected in respectively 7 and 5 studies. Cardiopulmonary functioning and mood disorders were scarcely investigated (both n=1). Maternal anti-SSA antibodies were associated with LD in offspring in one study. Other SLE-related antibodies were rarely studied.
This systematic review suggests that maternal SLE is associated with LD (specifically dyslexia), ASD, attention deficit and probably speech problems in offspring. However, over half of the studies were assigned a low or moderate evidence level. Therefore, further research is necessary to substantiate the found evidence and expand the scope to lesser researched areas such as cardiopulmonary functioning.
分析已发表的关于母体系统性红斑狼疮 (SLE) 对儿童不同发育方面影响的数据。
通过对 PubMed 和 Embase 进行系统性检索，查找 SLE 或与 SLE 相关的抗体以及儿童身体、神经认知、精神或运动发育结果的相关文献，以此进行综述。
在最初筛选出的 1853 篇文献中，共有 24 项队列研究和 4 项病例对照研究符合纳入标准。报道显示，SLE 后代的学习障碍 (LD) 发生率为 21.4%-26%，高于普通人群。有 4 项研究报告称，狼疮患儿存在阅读障碍和阅读问题，其发病率为 14.3%-21.6%，且男性发病率明显高于女性。此外，与对照组相比，狼疮患儿发生自闭症谱系障碍 (ASD) 的风险增加了两倍（n=1 项研究），言语障碍的风险增加了两到三倍（n=3 项研究），但后者无统计学意义。而在注意力缺陷（n=5 项研究）和行为障碍（n=3 项研究）方面的结果则更为多样化。在两项大型对照研究中，注意力障碍更为常见，3 项分析该主题的研究中有 2 项报告存在更多的行为障碍。最后，分别有 7 项和 5 项研究表明，智商和运动技能未受影响。仅有 1 项研究调查了心肺功能和情绪障碍（均为 n=1）。在一项研究中，母亲的抗 SSA 抗体与后代的 LD 相关。其他与 SLE 相关的抗体则很少被研究。
本系统性综述表明，母体 SLE 与后代的 LD（尤其是阅读障碍）、ASD、注意力缺陷和可能的言语问题相关。然而，超过一半的研究被评为低或中证据水平。因此，需要进一步研究来证实这些发现，并扩大研究范围，以涵盖心肺功能等研究较少的领域。
