系统性红斑狼疮合并妊娠80例临床分析

李霂; 徐建华; 王芬

摘要: 目的:了解系统性红斑狼疮(systemic lupus erythematosus,SLE)患者妊娠期病情变化及对胎儿的影响,探讨SLE患者妊娠时机及药物治疗的选择。方法:80例SLE患者86例次妊娠根据妊娠时患者疾病活动指数积分分为疾病稳定期妊娠组(稳定组)及疾病活动期妊娠组(活动组)。根据患者抗磷脂抗体(APL)检查结果分为APL阳性组及APL阴性组。根据患者妊娠时肾脏损伤情况分为狼疮性肾炎组(LN组)及非LN组。根据患者病程中是否联合使用免疫抑制剂分为联合治疗组及单用糖皮质激素(GCs)治疗组(单用GCs组)。根据患者妊娠期间是否使用羟氯喹(HCQ)分为HCQ维持治疗组(HCQ组)与未用HCQ组。记录患者的一般情况、临床表现、各项实验室检查结果、治疗情况、胎儿发育及分娩情况,计算妊娠前后疾病活动积分。结果:80例患者中,因妊娠病死3例,病死率为3.75%,病死患者均为未正规治疗,疾病高度活动者。胎儿死亡26例,存活60例,胎儿死亡率为30.2%,存活率69.8%,不良妊娠发生率66.3%,无胎儿畸形发生。稳定组与活动组不良妊娠发生率分别为58.8%和94.4%,差异有统计学意义(P0.01)。APL阴性组与APL阳性组不良妊娠结局发生率分别为61.1%和92.9%,差异有统计学意义(P0.05)。LN组与非LN组不良妊娠结局发生率分别为62.8%和8/8,差异无统计学意义(P0.05)。联合治疗组与单用GCs组不良妊娠结局发生率分别为38.5%和95.0%,差异有统计学意义(P0.01)。HCQ组与未用HCQ组不良妊娠结局发生率分别为58.3%和68.1%,差异无统计学意义(P0.05)。结论:SLE患者妊娠时机的选择,妊娠前及妊娠期治疗及母体APL阳性均可对胎儿的预后造成影响。加强对孕母及胎儿的监控,可以获得相对较满意的妊娠结局。

Abstract: Objective:To explore the impact of lupus flares on maternal and fetal outcomes in pregnant women with systemic lupus erythematosus(SLE)，and to determine the proper pregnancy time and curative therapy for them． Methods:Eighty-six pregnancies of 80 pregnant women with SLE were divided into the active group and stable group according to the disease activity index，the positive antiphospholipid antibody(APL) group and negative antiphospholipid antibody group according to the findings of APL，the lupus nephritis(LN) group and non-LN group according to the kidney damage in the process of pregnancy，the glucocorticoid(GCs) group and GCs group according to whether immunosuppressant was employed in the process of treatment，and the hydroxychloroquine(HCQ) group and non-HCQ group． The detailed clinical data and laboratory data of the SLE patients were recorded． Results:Three patients died due to pregnancy，with a mortality rate of 3． 75%． None of the death cases had received regular treatment and their diseases were all in high activity． Twenty-six fetuses died and 60 survived;the fetal mortality rate was 30． 2% and the survival rate 69． 8%． Poor pregnancy occurred in 66． 3% of the patients，with no fetal malformation． There were significant differences between the stable group and the active group in the rate of adverse pregnant outcomes(58． 8% vs 94． 4%，P 0． 01)． There were significant differences between the group with positive APL and the group with negative APL in the rate of adverse pregnant outcomes(61． 1% vs 92． 9%，P 0． 05)． There were no significant differences between the LN group and the non-LN group in the rate of adverse pregnant outcomes(62． 8% vs 8/8，P ＞0． 05)． There were significant differences between the group treated with GCs and immunosuppressive agents and the group only treated with GCs in the rate of adverse pregnant outcomes(38． 5% vs 95． 0%，P 0． 01)． There were no significant differences between the group treated with HCQ and the group without in the rate of adverse pregnant outcomes(58． 3% vs 68． 1%，P ＞0． 05)． Conclusions: The time of pregnancy，treatment before and during pregnancy，and positive APL might all influence the prognosis of the fetus of the women with SLE． Close monitoring may obtain relatively satisfactory fetal outcomes．

系统性红斑狼疮合并妊娠80例临床分析

Clinical study of 80 cases of pregnant women with systemic lupus erythematosus