系统性红斑狼疮孕妇的妊娠结局及血小板减少的危险因素
Pregnancy outcomes and risk factors for thrombocytopenia in pregnant patients with systemic lupus erythematosus.
作者信息
Fang Qing-Ying, Gan De-Hai, Huang Jia, Lian Fan
机构信息
Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, P.R. China.
Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, P.R. China.
出版信息
BMC Pregnancy Childbirth. 2025 Mar 25;25(1):344. doi: 10.1186/s12884-025-07451-0.
BACKGROUND
To compare pregnancy outcomes between systemic lupus erythematosus (SLE) patients with thrombocytopenia and those without, and to develop a nomogram for assessing the risk of developing SLE-related thrombocytopenia during pregnancy.
METHODS
Clinical data from 178 pregnant patients with SLE were analyzed. Patients were classified into thrombocytopenia and normal platelet groups using a platelet count cutoff of < 100 × 10^9/L. Pregnancy outcomes were compared between these groups. A nomogram was developed to identify factors associated with thrombocytopenia based on univariate and multivariable logistic regression analyses. The performance of the nomogram was assessed through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).
RESULTS
Among the 178 patients, 34 were in the thrombocytopenia group and 144 in the normal platelet group. SLE patients with thrombocytopenia had a significantly higher rate of active disease (55.9% vs. 5.6%, P < 0.001) and a higher SLE-Pregnancy Disease Activity Index (SLEPDAI) (4.71 ± 3.04 vs. 2.29 ± 1.88, P < 0.001). When comparing patients with thrombocytopenia (categorized by platelet counts < 50 × 10^9/L and > 50 × 10^9/L) to the control group, the incidence of severe preeclampsia (20.00% vs. 15.79% vs. 4.86%, P = 0.027) and postpartum hemorrhage (26.32% vs. 6.67% vs. 3.47%, P = 0.007) was also significantly higher in the thrombocytopenia group. This group exhibited elevated rates of pregnancy loss (73.33% vs. 31.58% vs. 4.17%, P < 0.001) and stillbirth (20.00% vs. 15.79% vs. 0.69%, P < 0.001). Active disease, previous abortion, and anti-β2GPI antibodies positivity were identified as independent factors of developing SLE-related thrombocytopenia during pregnancy. The area under the curve for the nomogram was 0.833 (95% CI: 0.753-0.913). Both the calibration curve and DCA indicated that the model performed well.
CONCLUSION
Thrombocytopenia in pregnant patients with SLE is associated with increased disease activity and a higher incidence of adverse outcomes, including pregnancy loss and stillbirth. The nomogram for developing thrombocytopenia during pregnancy may help clinicians improve the management of this group of patients.
CLINICAL TRIAL NUMBER
not applicable.
背景
比较血小板减少的系统性红斑狼疮（SLE）患者与未患血小板减少症的SLE患者的妊娠结局，并绘制列线图以评估妊娠期间发生SLE相关血小板减少症的风险。
方法
分析178例妊娠SLE患者的临床资料。采用血小板计数临界值<100×10^9/L将患者分为血小板减少组和血小板正常组。比较两组的妊娠结局。基于单因素和多因素逻辑回归分析绘制列线图以确定与血小板减少相关的因素。通过受试者工作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）评估列线图的性能。
结果
178例患者中，血小板减少组34例，血小板正常组144例。血小板减少的SLE患者疾病活动率显著更高（55.9%对5.6%，P<0.001），SLE妊娠疾病活动指数（SLEPDAI）更高（4.71±3.04对2.29±1.88，P<0.001）。将血小板减少患者（按血小板计数<50×10^9/L和>50×10^9/L分类）与对照组比较，血小板减少组重度子痫前期（20.（此处原文有误，推测应为20.00%）对15.79%对4.86%，P=0.027）和产后出血（26.32%对6.67%对3.47%，P=0.007）的发生率也显著更高。该组妊娠丢失率（73.33%对31.58%对4.17%，P<0.001）和死产率（20.00%对15.79%对0.69%，P<0.001）升高。疾病活动、既往流产和抗β2GPI抗体阳性被确定为妊娠期间发生SLE相关血小板减少症的独立因素。列线图的曲线下面积为0.833（95%CI：0.753 - 0.913）。校准曲线和DCA均表明该模型性能良好。
结论
妊娠SLE患者的血小板减少与疾病活动增加及不良结局发生率较高相关，包括妊娠丢失和死产。妊娠期间发生血小板减少症的列线图可能有助于临床医生改善对这组患者的管理。
临床试验编号
不适用。
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