妊娠合并系统性红斑狼疮的妊娠结局及危险因素分析

Pregnancy outcomes and risk factors analysis in patients with systemic lupus erythematous

目的:探讨可预测妊娠合并系统性红斑狼疮(SLE)不良母婴结局的孕早期临床与实验室指标。方法:对2014年1月1日至2019年10月1日期间武汉大学中南医院收治的67例妊娠合并SLE患者进行了回顾性分析,探讨孕妇妊娠起始的临床特征及实验室指标与不良母儿结局之间的关系。结果:67例患者中,有35例(52.2%)患者发生了胎儿或新生儿的不良妊娠结局,其中妊娠丢失8例(11.9%)。单因素分析提示疾病活动指数(P=0.018)、狼疮肾炎(P=0.022)、低补体血症(P=0.027)与不良妊娠结局有关;非计划性妊娠(P=0.021)、狼疮肾炎(P=0.02)与妊娠丢失有关。但多因素分析显示,仅孕早期疾病活动为不良妊娠结局的独立预后因素(OR=3.3,95%CI:1.204~9.042,P=0.02)。12例患者在妊娠过程中发生了母体疾病的进展或严重并发症,单因素分析显示妊娠期新发SLE(P=0.041)、疾病活动(P=0.013)、狼疮肾炎(P=0.011)与不良母体结局有关,而多因素分析显示狼疮肾炎是导致妊娠期母体不良结局的独立危险因素(OR=5.478,95%CI:1.399~21.459,P=0.015)。结论:SLE患者妊娠初始的疾病状态与不良结局相关,部分早期的临床及实验室特征可能成为不良母婴结局的预测指标。

Objective:To explore the laboratory indicators of early pregnancy that can predict pregnancy and systemic lupus erythematosus(SLE)adverse maternal and infant outcomes.Methods:A retrospective analysis was performed on 67 pregnant women with SLE who were admitted to Zhongnan Hospital of Wuhan University from January 1,2014 to October 1,2019.The relationship between the clinical characteristics of pregnant women′s initiation of pregnancy and laboratory tests and the adverse mother and child outcomes were analyzed.Results:A total of 35(52.2%)patients had adverse pregnancy outcomes,including 8 cases of pregnancy loss(11.9%).Univariate analysis suggested that disease activity index(P=0.018),lupus nephritis(P=0.022),and hypocomplementemia(P=0.027)were related to adverse pregnancy outcomes.Planned pregnancy(P=0.021)and lupus nephritis(P=0.02)were related to pregnancy loss.However,multivariate analysis showed that only disease activity during early pregnancy was an independent prognostic factor for adverse pregnancy outcomes(OR=3.3,95%CI:1.204-9.042;P=0.02).Twelve patients experienced maternal disease progression or severe complications during pregnancy.Univariate analysis showed that new SLE during pregnancy(P=0.041),disease activity(P=0.013),and lupus nephritis(P=0.011)were associated with poor maternal outcomes.Multivariate analysis showed that lupus nephritis was an independent risk factor for maternal adverse outcomes during pregnancy(OR=5.478,95%CI:1.399-21.459,P=0.015).Conclusion:The initial disease status of SLE patients is related to adverse outcomes,and some early clinical and laboratory characteristics may be predictors of adverse maternal and infant outcomes.