妊娠合并系统性红斑狼疮42例临床分析

Clinical Analysis of 42 Cases of Pregnant Patients with Systemic Lupus Erythematosus

目的:探讨妊娠合并系统性红斑狼疮(SLE)患者孕期病情活动与否对母婴结局的影响。方法:回顾性分析2007年1月至2013年12月北京大学第三医院收治的42例妊娠合并SLE患者的临床资料,SLE病情活动组23例,非活动组19例。结果:1除外流产,SLE病情活动组终止妊娠的孕周较非活动组小(36.2±2.8周vs 38.1±0.7周,P=0.021),早产率较非活动组高(46.7%vs 6.7%,P=0.035),活产儿平均体重低于非活动组(2456.2±754.6 g vs 2956.3±420.0 g,P=0.048)。2各类合并症中,妊娠合并狼疮肾炎发生率最高(19.0%),妊娠期高血压疾病在SLE病情活动组发生率明显高于非活动组(34.8%vs 5.3%,P=0.027),其他如妊娠期糖尿病、胎儿生长受限、羊水少、胎膜早破、前置胎盘等并发症两组间比较差异均无统计学意义(P>0.05)。3孕前每天激素用量>10 mg组流产及早产发生率明显高于每天激素用量≤10 mg组(55.6%vs 9.5%,75.0%vs 5.3%,P均<0.05)。结论:SLE患者妊娠时发生妊娠期高血压疾病、早产、低出生体重儿的几率在SLE病情活动时明显增加,建议在病情稳定半年以上或疾病缓解期受孕,控制孕前激素用量。孕前激素用量>10mg的患者流产及早产率高。

Objective ：To study the effects on maternal and infant outcomes of the patients who complicated with systemic lupus erythematosus with disease activity during pregnancy or not. Methods ：The clinical data of 42 cases of pregnant patients with systemic lupus erythematosus who admitted in Peking University third hospital be- tween 2007 and 2013 were retrospectively analyzed. Results：① Except for abortion,the termination of the gesta- tional age of the active group was lower than inactive group（36.2±2. 8 week vs 38. 1 ±0.7 week,P=0. 021 ）, preterm birth rates was higher than inactive group（46. 7% vs 6.7%, P = 0. 035） ,the middleweight of live births was lower than inactive group（2456.2±754.6 g vs 2956.3±420.0 g, P =0. 048）. ②ln all kinds of complica- tions,the incidence of pregnancy with lupus nephritis was the highest （19.0%）. The incidence of hypertensive disorder complicating pregnancy of the active group was higher than inactive group （34. 8% vs 5.3%, P = 0. 027）, there was no significant difference in other complications such as gestational diabetes mellitus, fetal growth restriction, oligoamnios, premature rupture of membranes and placenta previa（ P 〉 0.05）.③The incidence of abortion and preterm birth of the patients whose daily dosage of hormone was greater than 10 milligram before pregnancy were higher than the patients whose daily dosage was less than 10 milligram before pregnancy （55. 6% vs 9.5% ,75. 0% vs 5.3%, P 〈 0.05）. Conclusions：The incidence of pregnancy hypertensive disorder, preterm birth,low birth weight infant in the active SLE group is higher,so conception during the inactive SLE period and controlling the daily dosage of hormone before pregnancy may improve the outcome of mother and fetus.