系统性红斑狼疮合并妊娠患者的妊娠结局及其影响因素

Pregnancy Outcome and Its Influencing Factors among Pregnant Women with Systemic Lupus Erythematosus

目的探讨系统性红斑狼疮(SLE)合并妊娠患者的妊娠结局及其影响因素。方法选取2000年1月—2013年9月河北医科大学唐山临床医学院收治的SLE合并妊娠患者112例。将患者按照妊娠成功并分娩活婴与否分为妊娠成功组和妊娠失败组。比较两组患者狼疮性肾炎发生率、抗Ro/SSA抗体阳性率、抗La/SSB抗体阳性率、低补体C3及C4发生率、高血压发生率、抗心磷脂抗体(aCL)阳性率、雷诺现象发生率、狼疮复发率等,并采用多因素Logistic回归分析影响妊娠不良结局的因素。结果妊娠成功组75例,妊娠失败组37例。两组抗Ro/SSA抗体阳性率、抗La/SSB抗体阳性率、低补体C3及C4发生率、高血压发生率、雷诺现象发生率比较,差异均无统计学意义(P>0.05);妊娠成功组狼疮性肾炎发生率、抗aCL阳性率、狼疮复发率均低于妊娠失败组(P<0.05)。多因素Logistic回归分析结果显示,狼疮性肾炎、抗Ro/SSA抗体阳性、抗La/SSB抗体阳性、低补体C3及C4、高血压、抗aCL阳性、雷诺现象和狼疮复发是妊娠不良结局的影响因素(P<0.05)。结论狼疮性肾炎、抗Ro/SSA抗体阳性、抗La/SSB抗体阳性、低补体C3及C4、高血压、抗aCL阳性和雷诺现象及狼疮复发是导致不良妊娠结局的重要因素,因此,SLE合并妊娠患者须经风湿病和产科专家共同管理,针对孕期及产后进行免疫指标监测,有计划地进行妊娠管理以改善妊娠结局,防止或减少不良妊娠结局的发生。

Objective To investigate pregnancy outcome and its influencing factors among pregnant women with systemic lupus erythematosus（ SLE）. Methods 112 pregnant women with SLE who were admitted to Tangshan Clinical Medical College,Hebei Medical University from January 2000 to September 2013,were selected as study subjects. The patients who delivered a live infant were included into pregnancy success group,and the other patients were included into pregnancy failure group. The lupus nephritis incidence,anti- Ro /SSA positive rate,anti- La /SSB positive rate,incidence of low complement C3 and C4level,hypertension incidence,aCL positive rate,recurrence rate of lupus,and Raynaud＇s phenomenon incidence were compared between two groups of patients. Influencing factors for adverse pregnancy outcome were analysed by using multiple Logistic regression model. Results The pregnancy success group included 75 cases,the pregnancy failure group included 37 cases. There was no significant difference in anti- Ro /SSA positive rate,anti- La /SSB positive rate,incidence of low C3 and C4level,hypertension incidence,and Raynaud＇ s phenomenon incidence between two groups（ P〉0. 05）. Lupus nephritis incidence,aCL positive rate,and recurrence rate of lupus in pregnancy success group were significantly lower than those in pregnancy failure group（ P〈0. 05）. According to multiple Logistic regression analysis results,lupus nephritis,anti- Ro /SSA positive,anti- La /SSB positive, low levels of complement C3 and C4,aCL positive,recurrence of lupus,hypertension and Raynaud＇s phenomenon were important influencing factors for adverse pregnancy outcome（ P〈0. 05）. Conclusion Lupus nephritis,anti- Ro /SSA positive,anti- La /SSB positive,low levels of complement C3 and C4,hypertension,aCL positive,Raynaud＇s phenomenon and recurrence of lupus are important factors which lead to adverse pregnancy outcome. The rheumatologists and obstetricians should jointly manage pregnant women with SLE,immune parameters should be monitored during pregnancy and after delivery,systematic pregnancy management can improve pregnancy outcome,and reduce the incidence of adverse pregnancy outcome.