Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Gynecology and Obstetrics, University Medical Center Utrecht, Utrecht, Netherlands.
J Immunol Res. 2017;2017:2810202. doi: 10.1155/2017/2810202. Epub 2017 Dec 17.
To investigate the effect of hydroxychloroquine (HCQ) in pregnant women with systemic lupus erythematosus (SLE).
In SLE pregnancies of a single Dutch center (2000-2015), lupus activity and flares before and during pregnancy and postpartum were assessed using the SLE Disease Activity Index (SLEDAI)/SLEPDAI (SLEDAI adjusted for pregnancy). The association between HCQ use and pregnancy outcomes (early spontaneous abortion, fetal death, and preterm and term live birth) was analyzed using generalized estimating equations (GEE) accounting for the occurrence of multiple pregnancies per patient. Analyses were adjusted for antiphospholipid antibody (aPL) status.
110 pregnancies (63 mostly Caucasian patients) were included, of which, in 30, HCQ was used; overall occurrence of flares was low (non-HCQ group: 5 mild (6.4%) and 2 severe (2.6%); HCQ group: 2 mild (6.7%) and no severe flares). The HCQ group showed a trend towards lower dosage of prednisone (OR 0.2 (95% CI 0.0-1.4); = 0.10). Pregnancy outcomes were comparable between groups. Among preterm live births, pregnancy duration was significantly longer in HCQ users (2.4 weeks (95% CI 1.0-3.8; ≤ 0.001)).
HCQ use was associated with longer pregnancy duration in the vulnerable preterm birth population, underscoring the beneficial effect of HCQ use during pregnancy.
研究羟氯喹（HCQ）对系统性红斑狼疮（SLE）孕妇的影响。
在 2000 年至 2015 年期间，对荷兰某单一中心的 SLE 妊娠患者（共 110 例，63 例患者主要为高加索人种）进行了研究，使用系统性红斑狼疮疾病活动指数（SLEDAI）/SLEPDAI（SLEDAI 针对妊娠进行了调整）评估妊娠前后的狼疮活动和疾病发作情况。使用广义估计方程（GEE）分析了 HCQ 应用与妊娠结局（早期自然流产、胎儿死亡、早产和足月活产）之间的关系，GEE 考虑了每位患者发生的多次妊娠。分析调整了抗磷脂抗体（aPL）状态。
非 HCQ 组中，5 例（6.4%）轻度发作和 2 例（2.6%）重度发作；HCQ 组中，2 例（6.7%）轻度发作和无重度发作。HCQ 组的泼尼松剂量呈下降趋势（比值比 0.2（95%置信区间 0.0-1.4）； = 0.10）。两组的妊娠结局无差异。在早产活产中，HCQ 使用者的妊娠持续时间显著延长（2.4 周（95%置信区间 1.0-3.8）； ≤ 0.001））。
HCQ 应用与脆弱的早产人群的妊娠持续时间延长有关，这突显了 HCQ 在妊娠期间的有益作用。
