妊娠合并系统性红斑狼疮患者孕期病情活动的影响因素及其与妊娠结局的关系

Influential factors of systemic lupus erythematosus activity during pregnancy and its relationship with pregnancy outcome

目的探讨妊娠合并系统性红斑狼疮(SLE)患者孕期病情活动的影响因素及其与妊娠结局的关系。方法对1991年至2005年收治的66例妊娠合并 SLE 患者的临床资料进行回顾性分析。结果 (1)孕前病情不稳定、孕期新发病及孕期泼尼松用药不规范者均出现 SLE 病情活动;孕期 SLE 病情活动者32例(活动组),非活动者34例(非活动组)。(2)活动组患者发生子痫前期9例、胎儿生长受限(FGR)13例、治疗性流产7例和早产15例,非活动组分别为1例、5例、1例和4例,两组分别比较,差异有统计学意义(P 均<0.05)。(3)活动组患者不同器官损伤中,以肾损害对妊娠的影响最大;用 logistic 回归前进法筛选变量结果显示,肾损害是子痫前期、FGR 的独立危险因素。(4)孕期泼尼松用量每天≤15 mg 者子痫前期及胎儿丢失发生率分别为4.7%(2/43)及9.3%(4/43),用量每天≥20 mg 者的子痫前期及胎儿丢失发生率分别为33.3%(6/18)及44.4%(8/18),两者比较,差异有统计学意义(P<0.01)。结论孕前 SLE 病情不稳定、孕期新发病及孕期泼尼松用药不规范为 SLE 病情活动的重要影响因素。孕期 SLE 病情活动特别是肾损害与不良妊娠结局有密切关系。孕期泼尼松用量每天≥20 mg 者发生子痫前期及胎儿丢失的几率大于每天≤15 mg 者。

Objective To investigate the influential factors of systemic lupus erythematosus （SLE） activity during pregnancy and their relationship with pregnancy outcome. Methods A retrospective analysis of the clinical history of 66 pregnant women with SLE from 1991 to 2005 was carried out. Results （ 1 ） Those patients with unstable status progestation, patients being newly diagnosed with SLE during pregnancy or patients irregularly using prednisone became active during pregnancy. The disease was active in 32 cases （the active group） and inactive in 34 cases （the inactive group）. （2） Obstetric complications in the active group included： 9 cases of preeclampsia, 13 cases of fetal growth restriction （FGR）, 7 cases of therapeutic abortion and 15 cases of premature labor; and the corresponding numbers in the inactive group were 1, 5, 1 and 4, respectively. All the numbers were significantly different between the two groups （ P 〈 0. 05 ）. （3） Among all SLE injuries, the lupus nephropathy affected pregnancy mostly. With the logistic regression advanced method, we found the lupus nephropathy was the independent risk factor for preeclampsia and FGR. （4） The rates of preeclampsia, and fetal losses were 4. 7% （2/43） and 9.3% （4/43） in the patients taking prednisone less than 15 mg/day, and were 33.3% （6/18） and 44. 4% （8/18） in the patients taking prednisone more than 20 mg/day, being significantly different from the former （ P 〈 0. 01 ） . Conclusions Being unstable progestation, being newly diagnosed during pregnancy or irregular prednisone use are important influential factors of SLE activity. SLE flares during pregnancy, especially the lupus nephropathy correlate closely with the adverse pregnancy outcomes. The rates of preeclampsia, and fetal losses increase in the patients taking prednisone more than 20 mg/day compared with the patients taking prednisone less than 15 mg/day.