妊娠合并系统性红斑狼疮40例临床分析

CLINICAL ANALYSIS OF 40 CASES OF PREGNANCY COMPLICATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS

[目的]探讨妊娠合并系统性红斑狼疮的临床特点、孕产期处理及妊娠结局。[方法]对我院40例妊娠合并系统性红斑狼疮的临床资料进行回顾性分析。[结果](1)控制/缓解期25例,活动期15例(8例首次发病并确诊,7例病情由稳定转为活动);(2)40例患者中有37.5%出现产科并发症,其中胎儿宫内生长受限9例,羊水过少4例,妊娠期高血压疾病4例,产后出血2例;(3)娩出活婴37个,活动组妊娠丢失率为20%,而控制/缓解期组无一例妊娠丢失,差异有统计学意义(P=0.022);新生儿分娩孕周为35+1～40+3周,平均出生体重为(2812±473)g,控制/缓解期组与活动期组比较差异有统计学意义(P﹤0.05),活动期有一例新生儿为先天性SLE;(4)40例患者中有10例狼疮性肾炎(25%),其中9例处于活动期,其低体重儿及早产儿率为62.5%。[结论]在疾病的缓解期或控制期受孕,孕期加强母婴监护,正确使用肾上腺皮质激素,适时终止妊娠,多数SLE病例能获得好的妊娠结局。

[Objective]To explore the clinical characteristics,the treatment and the outcome of pregnancy complicated with systemic lupus erythematosus（SLE）.[Methods]The clinical data of 40 pregnant women complicated with SLE were retrospectively investigated.[Results]（1）25 cases were diagnosed to be controlled and inactive phase and 15 cases to be active phase（8 cases were first diagnosed to be SLE and the condition of illness of 7 cases turned to be active from inactive）;（2）Out of 40 cases,37.5% of them presented to be obstetric complication,which include 9 cases with fetal growth retradation（FGR）,4 cases with oligohydramnios,4 cases with hypertensive disorder complicating pregnancy and 2 cases of postpartum hemorrhage;（3）37 alive infants were delivered,the rate of pregnant loss was 20% in active group,and not any fetal was loss in inactive group,significant difference was found between the two groups（P = 0.022）;the average delivery gestational weeks were 35＋1-40＋3,and the mean birth-weight were 2812±473g. there were significant difference between the active and inactive groups（P﹤0.05）. One neonatal with inborn lupus erythematosus（NLE）was found in active group;（4）Out of 40 cases,10 cases were diagnosed to be lupus nephritis and 9 cases to be in active stage,both the rate of premature birth and low weight neonatal was 62.5%.[Conclusion]When in the inactive or control stage of SLE,with intensive guardianship for mother and infants,proper use of adrenal cortical hormone,and termination of pregnancy at the right time,most of the pregnant women with SLE could get well pregnancy outcome.