妊娠合并SLE孕期病情对妊娠结局的影响研究

Influences of active SLE on pregnancy outcome

目的探讨妊娠合并系统性红斑狼疮(SLE)患者孕期病情活动情况,及其对妊娠结局的影响。方法回顾分析64例妊娠合并SLE患者的临床资料,其中活动性SLE妊娠患者15例,非活动性SLE妊娠患者49例,妊娠期及产后均给予不同剂量的泼尼松龙控制病情,观察对比2组患者妊娠结局、围生儿情况及产科并发症情况。结果非活动性SLE妊娠期患者的足月产率高于活动性SLE妊娠期患者(均P<0.05);但2组患者的平均分娩孕周比较差异无统计学意义(t=4.523,P>0.05)。活动性SLE孕妇围生儿出现窘迫2例、轻度窒息及心肌损害各1例、重度窒息5例;非活动性SLE孕妇围生儿出现窘迫7例,无轻重度窒息、心肌损害。2组患者新生儿体重比较差异无统计学意义(t=3.687,P>0.05)。活动性和非活动性SLE妊娠期患者出现早产各5例、胎儿宫内生长受限(FGR)各6例,2组比较差异有统计学意义(均P<0.05);活动性SLE妊娠期患者出现子痫前期2例,而非活动性SLE妊娠期患者出现子痫前期各4例,2组比较差异无统计学意义(P>0.05)。结论糖皮质激素仍是治疗SLE的首选药物,活动期SLE可增加妊娠并发症发生率,患者需在孕期协作治疗并给予选择性妊娠指导。

Objective To explore the systemic lupus erythematosus（SLE） activity during pregnancy and its influence on the pregnant outcomes. Methods The clinical data of 64 cases of pregnancy with SLE were retrospectively analyzed. There were 15 cases of pregnancy with active SLE and 49 with inactive SLE. All of them received adequate dose of prednisolone during pregnancy and postpartum periods for disease control. The pregnancy outcomes, conditions of perineonate and obstetric complications were compared between the two groups. Results The rate of full-term birth in pregnancy with inactive SLE was higher than that in pregnancy with active SLE （ P 〈 0.05 ）, however, the average gestational weeks be- tween the two groups were not significant difference （ t = 4.523, P 〉 0.05 ）. There were 2 cases of distress, 1 case of mild asphyxia, 1 case of myocardial damage and 5 cases of severe asphyxia in the active group,while only there were 7 cases of distress in the inactive group, with without asphyxia and myocardial damage cases. The neonatal weight of the two groups had no statistical difference（ t = 3. 687 ,P 〉0.05 ）. There were 5 cases of premature delivery and 6 cases of fetal intrauterine growth restriction（FGR） in both groups, and the differences were statistically significant（ P 〈 0.05 ）. There were 2 cases of preeclampsia in the active group and 4 cases in the inactive group, the difference was not significant （ P 〉 0.05）. Conclusion Glucocorticoid was still the first choice for the treatment of SLE. The active SLE in pregnancy will increase the incidence of pregnancy complications. The compliance of patients during pregnancy and personalized pregnancy guide will improve the therapeutic efficacy.