Imperial Lupus Centre, Department of Medicine, Imperial College London, London, UK; Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, London, UK.
Divisions of Nephrology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Semin Nephrol. 2017 Jul;37(4):347-353. doi: 10.1016/j.semnephrol.2017.05.006.
Pregnancy associated with lupus, especially lupus nephritis, is often fraught with concern for both the mother and fetus. Thus, it is paramount that care begins preconception so that proper planning in terms of optimizing the medical regimen, discontinuation of fetotoxic agents, and treatment of active disease can occur. It is well known that active nephritis at the time of conception is associated with poor outcomes. Even with quiescent disease, recent data indicate that being lupus anticoagulant-positive, nonwhite or Hispanic, and using antihypertensive medications were all predictors of worse pregnancy outcomes. Further, prior lupus nephritis also predicts higher rates of preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. Differentiating lupus nephritis from preeclampsia often presents as a conundrum, but lupus nephritis can be confirmed by the presence of decreasing complement levels and increasing double-stranded DNA (dsDNA) antibody levels in addition to new onset hypertension and proteinuria. We hope that the more mechanistic approach of measuring angiogenic markers, which are diagnostic for preeclampsia, will be the standard of care in the future. Women with lupus and prior lupus nephritis can have successful pregnancies, but outcomes are dependent on "the art of planning" as well as close communication between the obstetrician, the nephrologist, and the rheumatologist.
与狼疮相关的妊娠，尤其是狼疮性肾炎，常常令母亲和胎儿都感到担忧。因此，至关重要的是，应在妊娠前开始进行护理，以便能够对医疗方案进行适当的规划，包括优化治疗、停止使用对胎儿有不良影响的药物，以及治疗活动性疾病。众所周知，在妊娠时患有活动性肾炎与不良结局相关。即使疾病处于静止状态，最近的数据表明狼疮抗凝阳性、非白种人或西班牙裔、以及使用抗高血压药物均是妊娠结局较差的预测因素。此外，既往狼疮性肾炎也预示着更高的子痫前期和 HELLP（溶血、肝酶升高、血小板计数降低）综合征的发生率。狼疮肾炎与子痫前期的鉴别常常颇具挑战性，但狼疮肾炎可通过补体水平下降和双链 DNA（dsDNA）抗体水平升高以及新出现的高血压和蛋白尿来确诊。我们希望，未来测量血管生成标志物的更具机制性的方法将成为标准的护理方法，这些标志物可用于诊断子痫前期。患有狼疮和既往狼疮性肾炎的女性可以成功妊娠，但结局取决于“规划的艺术”以及产科医生、肾病学家和风湿病学家之间的密切沟通。
