系统性红斑狼疮肾炎患者妊娠的前瞻性观察(附47例报告)

Prospective study of pregnancy in 47 patients with lupus nephritis

目的了解系统性红斑狼疮(SLE)肾炎患者妊娠的母婴风险。方法前瞻性观察我院1998—2006年47例SLE肾炎患者的妊娠结果,依据妊娠前SLE病情,将患者分为SLE缓解期妊娠(A组,37例)、非SLE缓解期妊娠(B组,6例)和妊娠期初发SLE(C组,4例),分别观察妊娠期及产后半年内母亲的SLE病情和胎儿结局。结果共45例患者分娩活婴(1例分娩双胎),2例患者因疾病活动而中止妊娠。无自然流产和死胎,无母婴死亡。A组中,妊娠期SLE肾炎活动7例,肾功能损害1例;中止妊娠1例,早产10例,足月产26例。B组中,妊娠期SLE肾炎活动5例,肾功能损害1例;中止妊娠1例,早产4例,足月产1例。C组中,妊娠期内无肾功能损害,早产2例,足月产2例。B组患者妊娠期SLE肾炎活动构成比显著低于A组(P<0.01)。结论SLE肾炎患者妊娠的关键在于妊娠时机的选择,疾病缓解期妊娠可有效降低母婴风险。

Objective To evaluate the maternal fetal risks during pregnancy in patients with lupus nephritis. Methods A prospective observation was done on the outcomes of pregnancies in 47 patients with lupus nephritis between 1998--2006 in Renji Hospital. The patients were divided into 3 groups： controlled lupus （Group A, n=37）, uncontrolled lupus （Group B, n=6） and lupus onset during pregnancy （Group C, n=4）. The intra-partum and postpartum lupus disease activity and the fetal outcomes were observed in all group within half year after delivery. Results Totally 45 patients had live deliveries, including 1 with twin. Two patients received therapeutical abortion due to severe disease flare. There was no natural abortion and stillbirth, nor maternal-fetal deaths. Seven patients in Group A had intra-partum lupus nephritis flare （19 %）; one had therapeutical abortion and 1 had transient renal damage; and 10 had preterm deliveries and 26 cases of full term deliveries. Five patients in Group B had intra-partum lupus nephritis flare （83%）; 1 had therapeutical abortion and 1 had permanent renal damage; and 4 had preterm deliveries and 1 had full term delivery. No renal deterioration was found in Group C; 2 patients had pre-term delivery and 2 had therapeutical abortion. There was significant difference in intra-partum lupus nephritis flare between Group A and Group B（P〈0.01）. Conclusion The key for a safe outcome of pregnancy in lupus nephritis patients is proper timing of conception. The control of lupus activity before pregnancy can effectively downregulate maternal-fetal risks. （Shanghai Med J, 2008,31 ： 332-334）