Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Clin Exp Rheumatol. 2018 Sep-Oct;36(5):871-878. Epub 2018 Apr 13.
To investigate the foetal outcomes and examine the predictive value of the third-trimester umbilical artery Doppler in systemic lupus erythematosus (SLE) pregnancies.
Data of 180 pregnancies in 175 SLE patients from Jan 2007 to Jan 2017 were analysed retrospectively. Pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) of the umbilical artery flow velocity data were monitored by Doppler ultrasound.
One or more composite adverse pregnancy outcomes (APOs) occurred in 46.7% of patients with SLE. A total of 62 (34.4%) pregnancies were pre-term birth, and 34 (18.9%) newborns were small for gestational age (SGA). Twenty-two of pregnancies (12.2%) resulted in foetal distress. In multivariate analysis, predictors of composite APOs included positive anti-Ro (OR 5.5, 95% CI 1.7-18.2, p=0.005) and low complement (OR 3.9, 95% CI 1.1-13.6, p=0.04). Doppler PI, RI, and S/D were significantly higher in the pre-term birth, SGA, and composite APO groups than in the patients without APOs. RI with cut-off values of 0.57 and 0.70 indicated the highest risk of pre-term birth and composite APOs, with sensitivities of 50.0% and 21.4%, as well as specificities of 59.6% and 97.7%, respectively. PI emerged as the best predictor of SGA. The optimal cutoff value for PI was 0.77, at which sensitivity (90.9%) and specificity (49.2%) had the best combination.
Pregnancies in lupus still had an increased risk of APOs in terms of pre-term birth. Third-trimester umbilical artery Doppler was useful in predicting pre-term birth, SGA, and composite APOs in lupus pregnancies.
探讨第三孕期脐动脉多普勒在系统性红斑狼疮（SLE）妊娠中的胎儿结局及预测价值。
回顾性分析 2007 年 1 月至 2017 年 1 月 175 例 SLE 患者 180 例妊娠的临床资料。采用多普勒超声监测脐动脉血流速度的搏动指数（PI）、阻力指数（RI）和收缩期/舒张末期比值（S/D）。
SLE 患者中，1 种或多种复合不良妊娠结局（APO）发生率为 46.7%。共 62 例（34.4%）早产，34 例（18.9%）新生儿为小于胎龄儿（SGA）。22 例（12.2%）妊娠出现胎儿窘迫。多因素分析显示，复合 APO 的预测因素包括抗 Ro 阳性（OR 5.5，95%CI 1.7-18.2，p=0.005）和补体低（OR 3.9，95%CI 1.1-13.6，p=0.04）。早产、SGA 和复合 APO 组的脐动脉 PI、RI 和 S/D 均显著高于无 APO 组。RI 截断值为 0.57 和 0.70 时，早产和复合 APO 的风险最高，灵敏度分别为 50.0%和 21.4%，特异性分别为 59.6%和 97.7%。PI 是预测 SGA 的最佳指标。PI 的最佳截断值为 0.77，此时灵敏度（90.9%）和特异性（49.2%）具有最佳组合。
狼疮妊娠仍存在早产等 APO 风险增加。第三孕期脐动脉多普勒对狼疮妊娠的早产、SGA 和复合 APO 有预测价值。
