Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
J Matern Fetal Neonatal Med. 2022 Oct;35(20):3909-3914. doi: 10.1080/14767058.2020.1843626. Epub 2020 Nov 3.
To identify predictors of systemic lupus erythematosus (SLE) flares during pregnancy in patients previously considered to be at low risk.
The retrospective cohort study included 54 singleton pregnancies, managed between 2005 and 2019, involving maternal diagnosed SLE at a low disease activity (SLE Disease Activity Index ≤4) for ≥12 months before conception and without anti-phospholipid antibodies. Pregnancy outcomes were compared between patients who had SLE exacerbations during pregnancy (flare group, = 21) and patients that did not have a flare (non-flare group, = 33).
The flare group had shorter gestational durations ( = .01), lower birth weights ( = .02), and a higher risk of emergent cesarean section ( = .002) compared with the non-flare group. The flare group demonstrated higher doses of prednisone ( = .04) at the time of conception as well as an increased rate of low 50% hemolytic complement (CH50) activity ( = .03) in the first trimester compared to the non-flare group. A decision tree drawn using a prednisone dose ≥10.5 mg/day and a low CH50 predicted SLE flares with a net accuracy of 78%.
A prednisone dose ≥10.5 mg daily and CH50 hypocomplementemia in early pregnancy are useful in the early detection of patients at a high risk of SLE exacerbation.
在先前被认为处于低风险的患者中，确定系统性红斑狼疮（SLE）妊娠期间疾病发作的预测因素。
这项回顾性队列研究纳入了 54 例单胎妊娠，这些妊娠发生在 2005 年至 2019 年期间，涉及在受孕前至少 12 个月疾病活动度低（SLE 疾病活动指数≤4）且无抗磷脂抗体的母体确诊 SLE。比较了在妊娠期间发生 SLE 加重的患者（发作组，n=21）和未发生发作的患者（非发作组，n=33）的妊娠结局。
与非发作组相比，发作组的妊娠时间更短（P=.01），出生体重更低（P=.02），急诊剖宫产的风险更高（P=.002）。与非发作组相比，发作组在受孕时的泼尼松剂量更高（P=.04），且在妊娠早期发生低 50%补体溶血（CH50）活性的比例更高（P=.03）。使用泼尼松剂量≥10.5mg/天和 CH50 低补体血症绘制的决策树预测 SLE 发作的准确率为 78%。
妊娠早期泼尼松剂量≥10.5mg/天和 CH50 低补体血症有助于早期发现 SLE 加重风险较高的患者。
