妊娠时机对妊娠合并系统性红斑狼疮病情及妊娠结局的影响

Influence of Conception Timing on Lupus Flares and Pregnancy Outcomes in Pregnant Women with Systemic Lupus Erythematosus

目的:探讨妊娠时机对妊娠合并系统性红斑狼疮(SLE)患者孕期病情及妊娠结局的影响。方法:对46例妊娠合并SLE孕妇的临床资料进行回顾性分析,按妊娠时机的不同分为两组:SLE控制期和缓解期达6个月以上怀孕者为指导性妊娠组(32例);SLE活动期怀孕者以及孕期新发SLE的病例为非指导性妊娠组(14例),比较两组患者孕期SLE的病情和妊娠结局的不同。结果:①指导性妊娠组孕期SLE的活动率和泼尼松用量分别为15.6%和9.6±1.1mg/d明显低于非指导性妊娠组100%和24.1±18.2mg/d(P=0.000,P=0.012)。②指导性妊娠组24小时尿蛋白定量、肌酐、抗dsDNA抗体等指标的异常率均较非指导性妊娠组明显降低(P=0.003,P=0.004,P=0.021)。③指导性妊娠组无一例母婴死亡;非指导性妊娠组产妇死亡1例,胎儿丢失5例。指导性妊娠组的活产率(100%)较非指导性妊娠组(64.3%)明显升高(P=0.001);胎儿丢失和胎儿生长受限发生率分别为0和18.8%,较非指导性妊娠组35.7%和50.0%明显降低(P=0.001,P=0.030)。结论:妊娠时机对妊娠合并SLE患者孕期是否出现狼疮活动以及妊娠结局,尤其是胎儿结局影响较大,选择在SLE病情稳定半年以上计划怀孕,妊娠结局较好。

Objective：To explore the influence of conception timing on lupus flares and pregnancy outcomes in pregnant women with systemic lupus erythematosus （SLE）.Methods：The clinical data of 46 pregnant women with SLE were retrospectively analyzed. According to the different conception timing, 46 gravidas with SLE were divided into two groups： 32 patients who had controlled SLE and remission duration over 6 months before conception belonged to guidance pregnant group. Active lupus disease before conception and new onset SLE during pregnancy belonged to nonguidance pregnant group （n=14）. The rate of lupus flares and pregnancy outcomes were compared between two groups.Results：①The rate of lupus flare and dosage of prednisone in guidance pregnant group were 15.6% and 9.6±1.1 mg/d, in nonguidance pregnant group was 100% and 24.1±18.2 mg/d, which was significant higher （P=0.000,P=0.012）. ② The abnormal rate of 24 hours proteinuria, creatine and anti-dsDNA antibody in guidance pregnant group were significantly lower than that in nonguidance pregnant group （P=0.003,P=0.004,P=0.021）.③There was no maternal or fetal death in guidance pregnant group; whereas 1 maternal death and 5 fetal losses occurred in nonguidance pregnant group. The alive birth rate in guidance pregnant group （100）was significantly higher than that in nonguidance pregnant group（64.3%）（P=0.001）.The incidence of fetal loss and fetal growth retardation in guidance pregnant group was 0 and 18.8% respectively, in nonguidance pregnant group was 35.7% and 50.0% which was obviously higher （P=0.001,P=0.030）.Conclusions：Conception timing for pregnant women with SLE has substantial influence on lupus flares and pregnant outcomes, especially on fetal outcomes. Planning conception in SLE remission duration over 6 months before conception can improve the pregnancy outcome.