系统性红斑狼疮对妊娠结局影响的病例对照研究

Pregnancy outcome in systematic lupus erythematosus:a case-control study

目的认识系统性红斑狼疮(SLE)对妊娠不良影响的程度。方法运用病例对照研究方法分析24例SLE妇女44次妊娠及48名健康妇女94次妊娠的结局。结果SLE组末次妊娠平均年龄为(29±4)岁,健康组为(29±4)岁;两组平均妊娠次数分别为(1.9±0.8)次/人和(2.0±0.8)次/人(P=0.7);活产率分别为56.8%和72.3%(P=0.07);去除人工流产后胎儿丢失率分别为28.6%和13.9%(OR=2.47,95%CI:0.82￣7.27,P=0.07);早产和/(或)分娩低体重儿分别为32%和1.5%(OR=20.67,95%CI:2.56￣926.38,P<0.01)。合并狼疮肾炎和/(或)高血压病例的胎儿丢失相对危险度为4.6(95%CI:1.08￣18.56,P=0.021。1年内有病情活动或妊娠初次发病者的胎儿丢失率分别为60%和15%,早产和/(或)低体重儿率分别为80%和50%,较病情稳定1年以上的SLE妊娠高(分别为6%和13.3%)。结论SLE对妊娠结局有较大的不良影响,表现为SLE妇女胎儿丢失、早产和分娩低体重儿的风险均高于健康妇女。合并狼疮肾炎或高血压的SLE妊娠,这些风险将进一步升高。SLE病情控制1年以上妊娠,胎儿的安全性提高。

Objective To understand the relative risk of systemic lupus erythematosus （SLE） on pregnancy outcome. Methods Outcomes of 44 pregnancies in 24 SLE patients were analyzed and compared with 94 pregnancies in 48 healthy women using the method of case-control study. Results Mean age at last pregnancy in SLE patients was 29±4 years, and 29±4 in controls. Mean pregnancy times were 1.9±0.8 in SLE and 2.0±0.8 in controls respectively （P=0.7）. Live birth rate was 56.8% and 72.3% respectively （P=0.07）; pregnancy loss rate was 28.6% and 13.9% （OR=2.47, 95%CI： 0.82-7.27, P=0.07）. Premature delivery and/or low weigh baby rate was 32% and 1.5% respectively （OR=20.67, 95% CI 2.56-926.38, P〈0.01）. The pregnancy loss rate in patients with lupus nephritis and/or hypertension was 42.9% （OR=4.64 95% CI： 1.08-18.56, P=0.02）. For patients who had active SLE within one year before pregnancy, pregnancy loss rate was 60% and premature and/or low weigh baby rate was 80%; for patients whose SLE were diagnosed after pregnancy, these figures were 75% and 50% respectively. Figures of these two group were higher than that of patients whose SLE were inactive for at least one year before pregnancy （6% and 13.3%）. Conclusion SLE has negative effect on the outcome of pregnancy in that there is a high pregnancy loss rate, premature and/or low weigh baby rate. Lupus nephritis and/or hypertension further increase these risks. Pregnancy outcome will improve if pregnancy is planned after SLE is inactive for at least one year.