补体活化对妊娠合并系统性红斑狼疮胎儿不良结局影响的相关性研究

Relationship between complement activation and maternal-fetus outcome of pregnancy complicated with systemic lupus erythematosus

目的探讨补体活化对抗磷脂抗体介导妊娠合并系统性红斑狼疮(SLE)胎儿不良结局的影响。方法选取2013年12月-2015年12月该院收治的20例妊娠合并SLE患者产后胎盘作为观察组,另选同期该院20例正常妊娠分娩孕妇产后胎盘作为对照组,比较两组孕妇妊娠结局、新生儿红斑狼疮发生情况,同时对孕妇产后胎盘进行常规的病理检查,并采用免疫组织化学法染色检测孕妇体内C1q和C4d的表达。结果观察组自然流产/死胎例数高于对照组(P<0.05);正常分娩例数、分娩孕周、新生儿出生体重及胎盘重量均低于对照组(P<0.05)。显微镜下对观察组SLE患者病理切片进行观察显示,组织均出现不同程度的灶性钙化、退变、炎症细胞浸润和局部梗死。观察组与对照组胎盘免疫组织化学法染色检测C1q表达比较,差异无统计学意义;观察组C4d免疫组织化学法染色阳性率和阳性积分分别为100%和(3.5±0.9)分,对照组为0%和0分,两组C4d免疫组织化学法染色阳性率和阳性积分比较,差异有统计学意义(P<0.05)。观察组20例孕妇中,非指导性妊娠组中1例新生儿确诊为新生儿红斑狼疮。指导性妊娠组未发生新生儿红斑狼疮。结论 SLE合并妊娠患者,胎儿丢失率较高,容易发生不良妊娠结局。SLE产妇胎盘切片免疫组织化学法染色检测母婴交界处C4d沉积情况与胎儿不良结局密切相关,在补体活化影响APL介导的妊娠合并SLE患者妊娠过程中,C4d可作为母婴不良结局的预测生物标志物,为SLE患者选择妊娠时机,以及再次妊娠的临床治疗提供依据。

Objective To explore the relationship between complement activation and antiphospholipid （APL） antibody associated maternal-fetus outcome of pregnancy complicated with systemic lupus erythematosus （SLE）. Methods Twenty cases of pregnant women complicated with SLE from December 2013 to December 2015 in our hospital were selected as research objects in the study group. At the same time, 20 cases of normal pregnant women were selected as the control group. The maternal-fetus outcome and incidence of neonatal lupus erythematosus were compared. Meanwhile, the Clq and C4d of the pregnant women were examined by placenta pathology and immunohistoehemistry and compared between the two groups. Results Com- pared with the control group, the spontaneous abortion （stillborn foetus） rate in the study group was statistically higher （P 〈 0.05）; however, the gestational week was shorter, the normal delivery rate and the weight of neonates and placentas in the study group were significantly lower （P 〈 0.05）. Pathological examination re- vealed 20 placentas of pregnant women in the study group were partly calcificed with degeneration of villi, thrombopoiesis, inflammatory cell infiltration and local infartion. There was no difference in the expression of the Clq between the two groups. The C4d immunohistochemical staining positive rate and the positive points in the study group were statistically higher than those in the control group （P 〈 0.05）. Neonatal lupus erythe- matosus was found in 1 case of the non-guidance-pregnancy group. Conclusions The pregnant women with SLE are prone to poor neonatal outcome with high pregnancy loss rate. C4d deposition in maternal-fetal junction of SLE pregnancies has close association with adverse fetal outcome. As a result, C4d could be selected as a biomarker for APL associated maternal-fetus consequence, which provides an evidence for timing of pregnancy and having a successful secondary pregnancy.