日本高安动脉炎患者的妊娠与分娩：一项全国性回顾性研究。

Pregnancy and childbirth in Takayasu arteritis in Japan: A nationwide retrospective study.

作者信息

Miyamae Takako, Manabe Yusuke, Sugihara Takahiko, Umezawa Natsuka, Yoshifuji Hajime, Tamura Naoto, Abe Yoshiyuki, Furuta Shunsuke, Nagafuchi Hiroko, Ishizaki Jun, Nakano Naoko, Atsumi Tatsuya, Karino Kohei, Amano Koichi, Kurasawa Takahiko, Ito Shuichi, Yoshimi Ryusuke, Ogawa Noriyoshi, Banno Shogo, Naniwa Taio, Ito Satoshi, Hara Akinori, Hirahara Shinya, Uchida Haruhito A, Onishi Yasuhiro, Murakawa Yohko, Komagata Yoshinori, Nakaoka Yoshikazu, Harigai Masayoshi

机构信息

Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.

Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.

出版信息

Mod Rheumatol. 2025 Feb 21;35(2):339-344. doi: 10.1093/mr/roae068.

DOI:10.1093/mr/roae068

PMID:39116014

Abstract

OBJECTIVES

This study aimed to understand the status quo of medical treatments and pregnancy outcomes in patients with Takayasu arteritis (TAK) and children's birth outcomes.

METHODS

This study retrospectively enrolled patients with TAK who conceived after the disease onset and were managed at medical facilities participating in the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis.

RESULTS

This study enrolled 51 cases and 68 pregnancies during 2019-21. Of these, 48 cases and 65 pregnancies resulted in delivery and live-born babies. The median age of diagnosis and delivery was 22 and 31 years, respectively. Preconception therapy included prednisolone (PSL) in 51 (78.5%, median 7.5 mg/day), immunosuppressants in 18 (27.7%), and biologics in 12 (18.5%) pregnancies. Six cases underwent surgical treatment before pregnancy. Medications during pregnancy included PSL in 48 (73.8%, median: 9 mg/day), immunosuppressants in 13 (20.0%), and biologics in 9 (13.8%) pregnancies. TAK relapsed in four (6.2%) and eight (12.3%) pregnancies during pregnancy and after delivery, respectively. Additionally, 13/62 (20.9%) preterm infants and 17/59 (28.8%) low-birth-weight infants were observed, and none had serious postnatal abnormalities.

CONCLUSIONS

Most pregnancies in TAK were manageable with PSL at ≤10 mg/day. Relapse during pregnancy and postpartum occurred in <20% of pregnancies.

摘要

目的

本研究旨在了解大动脉炎（TAK）患者的治疗现状、妊娠结局以及子代出生情况。

方法

本研究回顾性纳入了疾病发作后怀孕且在参与日本厚生劳动省难治性血管炎研究委员会的医疗机构接受治疗的TAK患者。

结果

本研究在2019年至2021年期间纳入了51例患者及68次妊娠。其中，48例患者及65次妊娠成功分娩并产下活婴。诊断时及分娩时的中位年龄分别为22岁和31岁。孕前治疗包括51次妊娠（78.5%，中位剂量7.5毫克/天）使用泼尼松龙（PSL）、18次妊娠（27.7%）使用免疫抑制剂以及12次妊娠（18.5%）使用生物制剂。6例患者在怀孕前接受了手术治疗。孕期用药包括48次妊娠（73.8%，中位剂量：9毫克/天）使用PSL、13次妊娠（20.0%）使用免疫抑制剂以及9次妊娠（13.8%）使用生物制剂。分别有4次（6.2%）和8次（12.3%）妊娠在孕期及产后出现TAK复发。此外，观察到13/62（20.9%）的早产儿和17/59（28.8%）的低体重儿，且均无严重的出生后异常。