患有系统性红斑狼疮的怀孕女性的预后
Prognosis in Pregnant Females With Systemic Lupus Erythematosus.
作者信息
Liu Enling, Zhou Yuxiu
机构信息
Department of Gynaecology and Obstetrics, Tangshan Clinical Medical College, Hebei Medical University, Tangshan, China.
Department of Rheumatology, Tangshan Clinical Medical College, Hebei Medical University, Tangshan, China.
出版信息
Arch Rheumatol. 2017 Apr 21;32(4):298-302. doi: 10.5606/ArchRheumatol.2017.6304. eCollection 2017 Dec.
OBJECTIVES
This study aims to analyze the relationship between pregnancy and lupus, and explore the risk factors that adversely affect maternal and infant outcomes.
PATIENTS AND METHODS
The pregnancy outcomes in 112 pregnant females (mean age 24.3±2.8 years; range 20 to 35 years) with systemic lupus erythematosus (SLE) were retrospectively analyzed. Pregnancy outcomes before and after pregnancy were compared, and the associations with lupus nephritis, positive anti-Ro/SSA antibody, positive La/SSB antibody, complement 3 and complement 4, high blood pressure, positive anti- cardiolipin (aCL) antibody, Raynaud's phenomenon, and lupus recurrence were evaluated. Factors contributing to adverse outcomes were analyzed using multinomial logistic regression.
RESULTS
The live birth rate in females diagnosed with SLE before a pregnancy was higher than that in females diagnosed with SLE after a pregnancy. The fetal mortality rate in females diagnosed with SLE after a pregnancy was higher than that in females diagnosed with SLE before a pregnancy. However, the abortion rate in females diagnosed with SLE before a pregnancy was also significantly higher than that in females diagnosed with SLE after a pregnancy. The incidence of preterm birth in females diagnosed with SLE after a pregnancy was higher than that in females diagnosed with SLE after a pregnancy. Preterm birth was more likely to occur in females positive for Ro/SSA antibody. Patients with hypertension and Raynaud's phenomenon had a higher risk of intrauterine growth retardation. In addition, the presence of aCL antibody was associated with pregnancy loss. Multinomial logistic regression analysis showed that many factors might be associated with adverse pregnancy outcomes, including lupus nephritis, positive Ro/SSA antibody, positive La/SSB antibody, complement 3 and complement 4, positive aCL antibody, lupus recurrence, hypertension, and Raynaud's phenomenon.
CONCLUSION
Lupus nephritis, Ro/SSA antibody, aCL antibody, hypertension, Raynaud's phenomenon, and lupus recurrence are important factors associated with adverse pregnancy outcomes.
目的
本研究旨在分析妊娠与狼疮之间的关系，并探讨对母婴结局产生不利影响的危险因素。
患者与方法
回顾性分析112例系统性红斑狼疮（SLE）妊娠女性（平均年龄24.3±2.8岁；年龄范围20至35岁）的妊娠结局。比较妊娠前后的妊娠结局，并评估其与狼疮性肾炎、抗Ro/SSA抗体阳性、La/SSB抗体阳性、补体3和补体4、高血压、抗心磷脂（aCL）抗体阳性、雷诺现象及狼疮复发的相关性。采用多项逻辑回归分析导致不良结局的因素。
结果
妊娠前诊断为SLE的女性活产率高于妊娠后诊断为SLE的女性。妊娠后诊断为SLE的女性胎儿死亡率高于妊娠前诊断为SLE的女性。然而，妊娠前诊断为SLE的女性流产率也显著高于妊娠后诊断为SLE的女性。妊娠后诊断为SLE的女性早产发生率高于妊娠后诊断为SLE的女性。Ro/SSA抗体阳性的女性更易发生早产。患有高血压和雷诺现象的患者发生胎儿生长受限的风险更高。此外，aCL抗体的存在与妊娠丢失有关。多项逻辑回归分析表明，许多因素可能与不良妊娠结局相关，包括狼疮性肾炎、Ro/SSA抗体阳性、La/SSB抗体阳性、补体3和补体4、aCL抗体阳性、狼疮复发、高血压及雷诺现象。
结论
狼疮性肾炎、Ro/SSA抗体、aCL抗体、高血压、雷诺现象及狼疮复发是与不良妊娠结局相关的重要因素。
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