妊娠合并SLE患者孕期病情对妊娠结局的影响

Effect of pregnancy combined with systemic lupus erythematosus on pregnancy out- come

目的:探讨妊娠期系统性红斑狼疮(SLE)患者病情发展情况及其对妊娠结局的影响。方法:根据妊娠期SLE病情活动情况将38例SLE孕妇分为活动期12例(A组)及非活动期26例(B组),对比分析两组患者母婴并发症情况及妊娠结局,并对影响患者妊娠结局的相关因素进行Logistic多因素分析。结果:A组患者SLE活动率、SLE疾病活动指数(SLEDAI)评分、泼尼松平均用量及皮疹、关节炎、脱发、尿素氮水平、血清肌酐(Cr)水平、口腔溃疡等临床症状发生率显著高于B组,差异有统计学意义(P<0.05)。经Logistic多因素分析可知,SLEDAI评分、肾功能衰竭、尿蛋白水平、补体水平是影响妊娠合并SLE患者妊娠结局的独立危险因素。结论:SLE活动期孕妇不良妊娠结局发生率较高,肾功能衰竭、尿蛋白水平、补体水平的升高与妊娠不良结局有密切关系,因此孕期应加强对SLE患者尤其是活动期患者的妊娠指导,降低该类患者不良妊娠发生率。

Objective： To explore the progression of systemic lupus erythematosus （SLE） in pregnant women and its impact on pregnancy outcome. Methods： Thirty- eight SLE pregnant women were divided into active phase （12 cases, group A） and inactive phase （26 cases, group B） according to the progression condition of SLE; the maternal and infantile complications and pregnancy outcomes in the two groups were compared and analyzed ; the related influencing factors of pregnancy outcome were analyzed by multivariate logistic analysis. Results： The SLE active ratio, SLE disease activity index （SLEDAI） score, mean dose of prednisone, the incidence rates of clinical symp- toms （rash, arthritis, alopecia, and dental ulcer）, urea nitrogen level, and serum creatinine level in group A were statistically significantly higher than those in group B （ P 〈 0.05 ） . Multivariate logistic analysis showed that SLEDAI score, kidney failure, urine protein level, and complement level were independent risk factors affecting pregnancy outcome of SLE pregnant women. Conclusion： The incidence rate of ad- verse pregnancy outcome in SLE pregnant women during active phase is relatively high; kidney failure, urine protein level, and complement level are closely correlated with adverse pregnancy outcome; so guidance during gestational period should be strengthened among SLE preg- nant women to reduce the incidence rate of adverse pregnancy in these patients, especially the patients during active phase.