计划妊娠的系统性红斑狼疮患者的母婴结局：一项回顾性多中心研究。
Fetal and Maternal Outcomes of Planned Pregnancy in Patients with Systemic Lupus Erythematosus: A Retrospective Multicenter Study.
机构信息
Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou 510080, China.
Department of Rheumatology and Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou 510080, China.
出版信息
J Immunol Res. 2018 Sep 3;2018:2413637. doi: 10.1155/2018/2413637. eCollection 2018.
OBJECTIVE
To investigate the fetal and maternal outcomes as well as predictors of APOs in women with SLE who conceived when the disease was stable, the so-called "planned pregnancy." . A retrospective multicenter study of 243 patients with SLE who underwent a planned pregnancy was performed. APOs in fetus and mothers were recorded.
RESULTS
The average age at conception was 28.9 ± 3.9 years. Duration of SLE prior to pregnancy was 4.4 ± 4.3 years. Fetal APOs occurred in 86 (86/243, 35.4%) patients. Preterm births, intrauterine growth retardation (IUGR), fetal distress, and fetal loss accounted for 22.2%, 14.8%, 11.1%, and 4.9%, respectively. Forty-two preterm infants (42/54, 77.8%) were delivered after the 34th week of gestation. All the preterm infants were viable. Fifty-two patients (52/243, 21.4%) had disease flares, among which 45 cases (45/52, 86.5%) were mild, 6 (6/52, 11.5%) were moderate, and 1 (1/52, 1.9%) was severe. Disease flares were mainly presented as active lupus nephritis (41/52, 78.8%), thrombocytopenia (10/52, 19.2%), and skin/mucosa lesions (9/52, 17.3%). Pregnancy-induced hypertension (PIH) occurred in 29 patients, among which 3 were gestational hypertension and 26 were preeclampsia. Multiple analysis showed that disease flares (OR, 8.1; CI, 3.8-17.2) and anticardiolipin antibody positivity (OR, 7.4; CI, 2.5-21.8) were associated with composite fetal APOs.
CONCLUSION
Planned pregnancy improved fetal and maternal outcomes, presenting as a lower rate of fetal loss, more favorable outcomes for preterm infants, and less severe disease flares during pregnancy.
目的
研究在疾病稳定时计划妊娠的系统性红斑狼疮（SLE）患者的胎儿和母体结局以及不良围产儿结局（APO）的预测因素。方法：进行了一项回顾性多中心研究，纳入了 243 例接受计划妊娠的 SLE 患者。记录胎儿和母亲的 APO。结果：平均受孕年龄为 28.9±3.9 岁。妊娠前 SLE 病程为 4.4±4.3 年。86（86/243，35.4%）例患者发生胎儿 APO。早产、宫内生长受限（IUGR）、胎儿窘迫和胎儿丢失分别占 22.2%、14.8%、11.1%和 4.9%。42 例（42/54，77.8%）早产儿在 34 周后分娩。所有早产儿均存活。52 例（52/243，21.4%）患者出现疾病活动，其中 45 例（45/52，86.5%）为轻度，6 例（6/52，11.5%）为中度，1 例（1/52，1.9%）为重度。疾病活动主要表现为狼疮肾炎活动（41/52，78.8%）、血小板减少（10/52，19.2%）和皮肤/黏膜病变（9/52，17.3%）。29 例患者发生妊娠高血压（PIH），其中 3 例为妊娠期高血压，26 例为子痫前期。多因素分析显示，疾病活动（OR，8.1；95%CI，3.8-17.2）和抗心磷脂抗体阳性（OR，7.4；95%CI，2.5-21.8）与复合胎儿 APO 相关。结论：计划妊娠改善了胎儿和母体结局，表现为胎儿丢失率降低，早产儿结局更有利，妊娠期间疾病活动程度较轻。
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