Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China.
Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China.
J Autoimmun. 2022 Oct;132:102864. doi: 10.1016/j.jaut.2022.102864. Epub 2022 Jul 21.
Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease that predominantly affects women of childbearing age and results in various adverse pregnancy outcomes (APOs). Pregnancy was formerly discouraged in patients with SLE because of unstable disease activity during the gestation period, increased thrombosis risk, severe organ damage, and inevitable side effects of immunosuppressive agents. Currently, most patients with SLE have successful pregnancies due to preconception counselling, strict monitoring, and improved therapy with minimised complications for both the mother and foetus. Hydroxychloroquine (HCQ) is extensively used and is beneficial for improving pregnancy outcomes. However, pregnant women with SLE have a high-risk of APOs, such as disease flare, preterm birth, intrauterine growth restriction (IUGR), preeclampsia, and pregnancy loss. Better understanding of the changes in maternal immunity and serum biomarkers, as well as their relationships with SLE-related APOs progression, would facilitate the investigation of molecular mechanisms for triggering and ameliorating APOs. Furthermore, it would enable us to explore and develop novel and effective therapeutic strategies to prevent disease activation. Therefore, this review briefly introduces the interaction between pregnancy outcomes and SLE, elucidates pathophysiological and immunological changes during SLE pregnancy. Furthermore, this review systematically expounds on the effective predictors of APOs and the molecular mechanisms underlying the SLE-related APOs to provide a solid foundation for the advanced management of lupus pregnancy.
系统性红斑狼疮（SLE）是一种全身性自身免疫性炎症性疾病，主要影响育龄妇女，导致各种不良妊娠结局（APO）。由于妊娠期间疾病活动不稳定、血栓形成风险增加、严重器官损伤以及免疫抑制剂的不可避免的副作用，以前不鼓励 SLE 患者怀孕。目前，由于孕前咨询、严格监测以及改善治疗，大多数 SLE 患者都能成功怀孕，从而减少了母婴并发症。羟氯喹（HCQ）广泛应用于改善妊娠结局。然而，SLE 孕妇发生 APO 的风险较高，如疾病发作、早产、宫内生长受限（IUGR）、子痫前期和流产。更好地了解母体免疫和血清生物标志物的变化，以及它们与 SLE 相关 APO 进展的关系，有助于研究触发和改善 APO 的分子机制。此外，它还可以使我们能够探索和开发新的有效的治疗策略来预防疾病的激活。因此，本综述简要介绍了妊娠结局与 SLE 之间的相互作用，阐明了 SLE 妊娠期间的病理生理和免疫学变化。此外，本综述系统地阐述了 APO 的有效预测因子和 SLE 相关 APO 的分子机制，为狼疮妊娠的高级管理提供了坚实的基础。
