稳定型狼疮患者在妊娠及产后期间出现疾病活动（ flares ）的频率较低。
Low frequency of flares during pregnancy and post-partum in stable lupus patients.
机构信息
Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
Albert Einstein College of Medicine, New York, NY, USA.
出版信息
Arthritis Res Ther. 2020 Mar 19;22(1):52. doi: 10.1186/s13075-020-2139-9.
BACKGROUND
Lupus patients are at risk for pregnancy loss, and it has been generally accepted that women with SLE should have low disease activity prior to conception. However, there are conflicting results regarding the effect of pregnancy on SLE flares. This study aims to identify predictors of flares during and after pregnancy in SLE patients with inactive or stable disease activity during the first trimester and to characterize and estimate the frequency of post-partum flares in these patients.
METHODS
SLE patients in the multicenter, prospective PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study were evaluated for flares during and after pregnancy using the SELENA-SLEDAI Flare Index. Flares during pregnancy were assessed in all 384 patients and post-partum flares in 234 patients with study visits 2-6 months post-partum. Logistic regression models were fit to the data to identify independent risk factors for flare.
RESULTS
During pregnancy, 20.8% of patients had mild/moderate flares and 6.25% had severe. Post-partum, 27.7% of patients had mild/moderate flares and 1.7% had severe. The mild flares rarely required treatment. Younger age, low C4 and higher PGA at baseline were independently associated with higher risk of having at least one mild/moderate or severe flare during pregnancy. Older patients were at decreased risk of flare, as well as those with quiescent disease at baseline. No variables evaluated at baseline or the visit most proximal to delivery was significantly associated with risk of flare post-partum. Medications were not associated with flare during or after pregnancy.
CONCLUSION
In patients with inactive or stable mild disease activity at the time of conception, lupus disease flares during and after pregnancy are typically mild and occur at similar rates. Flares during pregnancy are predicted by the patients' age and clinical and serological activity at baseline.
背景
狼疮患者有流产风险，一般认为 SLE 患者应在受孕前疾病活动度较低。然而，关于妊娠对 SLE 发作的影响存在矛盾的结果。本研究旨在确定 SLE 患者在妊娠期间和妊娠后出现活动的预测因素，这些患者在妊娠早期疾病活动处于不活动或稳定状态，并对这些患者的产后发作进行特征描述和频率估计。
方法
使用 SELENA-SLEDAI 发作指数，对多中心前瞻性 PROMISSE（妊娠结局预测：抗磷脂抗体综合征和系统性红斑狼疮的生物标志物）研究中的 SLE 患者进行妊娠期间和妊娠后发作的评估。在所有 384 例患者中评估妊娠期间的发作，在 234 例有研究就诊的患者中评估产后发作，就诊时间为产后 2-6 个月。拟合逻辑回归模型以确定发作的独立危险因素。
结果
在妊娠期间，20.8%的患者出现轻度/中度发作，6.25%的患者出现重度发作。产后，27.7%的患者出现轻度/中度发作，1.7%的患者出现重度发作。轻度发作很少需要治疗。年龄较小、基线时 C4 较低和 PGA 较高与妊娠期间至少出现一次轻度/中度或重度发作的风险增加独立相关。基线时疾病静止或年龄较大的患者发作风险降低，基线时无变量与产后发作风险显著相关。
结论
在受孕时疾病活动处于不活动或轻度稳定状态的患者中，妊娠期间和妊娠后狼疮疾病发作通常为轻度，发生率相似。妊娠期间的发作由患者的年龄和基线时的临床和血清学活动预测。
Zotero 插件