印度女性 Takayasu 动脉炎的产科结局较差。
Poor obstetric outcomes in Indian women with Takayasu arteritis.
机构信息
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
出版信息
Adv Rheumatol. 2020 Mar 12;60(1):17. doi: 10.1186/s42358-020-0120-6.
INTRODUCTION
Takayasu's arteritis (TA) affects young women in the childbearing age group. We studied obstetric outcomes in these patients before and after disease onset.
METHODS
Women aged more than 18 years with Takayasu's arteritis (ACR 1990 criteria) were included. Demographic data, clinical features, disease activity using Indian Takayasu Arteritis clinical score (ITAS), Disease Extent Index for TA (DEI.TaK) and damage assessment using TA Damage score (TA), history of conception and maternal and fetal outcomes were recorded from hospital records and telephonic interview. Results are in median and IQR.
RESULTS
Of the 64 women interviewed, aged 29 (24-38) years and disease duration 5 (4-10) years, 74 and 38 pregnancies had occurred before and after disease diagnosis in 29 and 20 women respectively. In eight, the diagnosis was made during pregnancy. Age at disease onset was 22 (18-30) years. Type 5 disease was the most common (n = 32, 59.3%), and an equal number of patients had Ishikawa's class I and II disease (n = 26, 40.6%). Median ITAS (n = 44) was 13 (7-16), DEI.Tak 12.5 (9-16.75) and TADS 8 (6.5-10). Twenty-five patients wanted to get pregnant, of which 8 (32%) did not do so because of their disease. Fifteen were unmarried of whom 6 did not marry due to disease. Obstetric outcomes were poorer in pregnancies that occurred after the onset of disease as compared with those before it (RR = 1.5, p = 0.01). Pregnancies after the onset of TA carried a very high risk of maternal [RR3.9 (1.8-8.5), P < 0.001] as well as fetal complications [RR = 2.0 (1.2-3.4), p = 0.001]. Hypertension was the most common maternal complication and occurred most often in the last trimester. The baby weight at birth was lower in pregnancies after disease (2.3 vs. 3.0, p = 0.01). Wong's score greater than or equal to 4 predicted lower birth weight (p = 0.04). ITAS, ITAS-A, DEI. Tak and TADS could not predict obstetric outcomes, and ITAS score exhibited moderate correlation with DEI. Tak (r = 0.78) and TADS (r = 0.58).
CONCLUSION
Women with TA suffer from extremely high risk of poor maternal and foetal outcomes. Wong's scoring can be useful to predict birth weight.
简介
Takayasu 动脉炎（TA）影响生育年龄的年轻女性。我们研究了这些患者在发病前后的产科结局。
方法
纳入年龄大于 18 岁的 Takayasu 动脉炎（ACR 1990 标准）患者。从病历和电话访谈中记录人口统计学数据、临床特征、采用印度 Takayasu 动脉炎临床评分（ITAS）的疾病活动度、疾病程度指数（DEI.TaK）和 TA 损伤评分（TA）评估的损伤情况、妊娠史以及母婴结局。结果以中位数和四分位距（IQR）表示。
结果
在接受采访的 64 名女性中，年龄 29（24-38）岁，病程 5（4-10）年，29 名女性在诊断前和 20 名女性在诊断后分别有 74 次和 38 次妊娠。8 例在妊娠期间确诊。发病年龄为 22（18-30）岁。最常见的是 5 型疾病（n=32，59.3%），Ishikawa 1 型和 2 型疾病的患者数量相等（n=26，40.6%）。44 名患者的 ITAS 中位数为 13（7-16），DEI.Tak 为 12.5（9-16.75），TADS 为 8（6.5-10）。25 名患者希望怀孕，其中 8 名（32%）因疾病未怀孕。15 名未婚，其中 6 名因疾病未结婚。与发病前相比，发病后妊娠的母婴结局更差（RR=1.5，p=0.01）。TA 发病后妊娠的母婴并发症风险极高[RR3.9（1.8-8.5），p<0.001]以及胎儿并发症[RR=2.0（1.2-3.4），p=0.001]。高血压是最常见的产妇并发症，最常发生在妊娠晚期。发病后妊娠的婴儿出生体重较低（2.3 与 3.0，p=0.01）。Wong 评分≥4 预测出生体重较低（p=0.04）。ITAS、ITAS-A、DEI.Tak 和 TADS 不能预测产科结局，ITAS 评分与 DEI 具有中度相关性。Tak（r=0.78）和 TADS（r=0.58）。
结论
TA 患者母婴结局风险极高。Wong 评分有助于预测出生体重。
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