妊娠合并系统性红斑狼疮的妊娠结局及预后

Pregnant outcomes and prognosis of women complicated with systemic lupus erythematosus

目的了解妊娠合并系统性红斑狼疮（systemic lupus erythematosus，SLE）的临床特点、妊娠结局及远期预后。方法对我院34例妊娠合并SLE患者的临床资料进行回顾性分析，并对其中26例患者进行了0．5～15年的随访。结果（1）34例患者，共35次妊娠，其中妊娠时处于缓解期8例，控制期8例，活动期1例，孕期初发者（妊娠后诊断者）18例（10例于孕期确诊，8例妊娠终止后确诊）；（2）妊娠前诊断的病情缓解组和控制组内分别有2例、3例SLE在妊娠期活动，孕期SLE恶化最常见的临床表现依次为蛋白尿、乏力、水肿、高血压、皮疹，血C3下降；（3）孕期初发组中，7例（38．9％）初始表现为蛋白尿、高血压、水肿等妊娠期高血压的症状；（4）病情缓解组患者的年龄显著大于孕期初发组[（32．4±5．5）岁和（26．6±3．9）岁，P-0．034]，产后随访显示病情缓解组狼疮性肾炎活动者1例，显著低于孕期初发组（1／4和100％，P-0．004），亦低于病情控制组（6／6，P-0．033）。结论SLE患者妊娠后对肾脏的损害与其年龄无关，而取决于孕前SLE病情，在SLE缓解期妊娠对肾脏远期损害最低。孕期初发SLE患者肾脏远期损伤较重，预后不良。

Objective To understand the clinical features, management, pregnant outcomes and prognosis of pregnant women complicated with systemic lupus erythematosus （SLE）. Methods Retrospective analysis of 34 women （35 pregnancies） complicated with SLE were conducted and 26 of them were followed up for 0.5 - 15 years. Results （1） Out of the 35 pregnancies in these 34 women, 8 were in remission stage, 8 in the well-controlled period, 1 in active phase and 18 were primary onset （10 diagnosed during the pregnancy, and 8 after terminations） during the pregnancy. （2） Among those diagnosed during the pregnancy, 2 women in the remission group and 3 in the wellcontrolled group were in the active stage of SLE. The several most common clinical manifestations indicating SLE deterioration were proteinuria, fatigue, edema, hypertension, erythra and decreased serum C3. （3） In women with onset during the pregnancy, 7 （38.9%） presented with proteinuria, edema and hypertension which similar to symptoms of gestational hypertension. （4） The average maternal age of the remission group was much older than those women with onset during pregnancy [（32.4±5.5） years vs （26.6±3.9） years, P=0. 034]. while the proportion of active lupus nephritis was lower than that of the later （1/4 vs 16/16, P=0. 004） and the well-controlled group （1/4 vs 6/6, P=0. 033） during post-partum follow-ups. Conclusions Pregnancy prompted lupus nephritis has nothing to do with maternal age, but the stage of SLE. Patients who conceived in the remission stage are the least likely to have nephritic damage. Although women with onset during the pregnancy is relatively young, they are expected to have more serious renal damage and poor prognosis.