Huong D L, Wechsler B, Piette J C, Arfi S, Gallinari C, Darbois Y, Frances C, Godeau P
Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Br J Rheumatol. 1996 Nov;35(11):1184-6. doi: 10.1093/rheumatology/35.11.1184.
We report on four women with systemic lupus erythematosus who developed two types of complications after ovulation-induction therapy for primary or secondary infertility. Primary infertility was associated with endometriosis in one patient. Three had previously known systemic lupus erythematosus. All had inactive disease at onset of ovulation-induction therapy. Three patients developed symptoms consistent with moderate lupus flare a few weeks after the onset of ovulation-induction therapy. One patient developed inferior vena cava and unilateral left renal vein thrombosis. No patient became pregnant. A high oestrogen level induced by ovulation-induction therapy may explain the occurrence of lupus flare in patients with prior inactive lupus. All our patients had prior asymptomatic antiphospholipid antibodies. One patient developed a major thrombotic event. The presence of antiphospholipid antibodies increases the thrombotic risk related to ovulation-induction therapy. We conclude that ovulation-induction therapy should be restricted to patients with long-standing inactive systemic lupus erythematosus. A preventive increase of the corticosteroid dosage should be proposed in addition to heparin or antiaggregant therapy for those with prior asymptomatic antiphospholipid antibodies, or with heparin therapy for those with prior antiphospholipid antibody-related events.
我们报告了四名系统性红斑狼疮女性患者，她们在因原发性或继发性不孕进行排卵诱导治疗后出现了两种并发症。一名患者的原发性不孕与子宫内膜异位症有关。三名患者既往已知患有系统性红斑狼疮。所有患者在排卵诱导治疗开始时疾病均处于非活动期。三名患者在排卵诱导治疗开始几周后出现了与中度狼疮活动相符的症状。一名患者发生了下腔静脉和左侧单侧肾静脉血栓形成。没有患者怀孕。排卵诱导治疗导致的高雌激素水平可能解释了既往狼疮非活动期患者出现狼疮活动的原因。我们所有患者既往均有无症状抗磷脂抗体。一名患者发生了严重血栓事件。抗磷脂抗体的存在增加了与排卵诱导治疗相关的血栓形成风险。我们得出结论，排卵诱导治疗应仅限于长期处于非活动期的系统性红斑狼疮患者。对于既往有无症状抗磷脂抗体的患者，除肝素或抗聚集治疗外，应建议预防性增加皮质类固醇剂量；对于既往有抗磷脂抗体相关事件的患者，应给予肝素治疗。
