13例系统性红斑狼疮患者避孕措施选择的临床分析

Contraceptive methods for women with systemic lupus erythematosus:13 cases of clinical analysis

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者流产后避孕措施的选择并随访避孕结局。方法对13例2014年2月至2017年2月在四川大学华西第二医院行人工流产术并接受了流产后关爱(Post-Abortion Care,PAC)咨询的SLE患者进行回顾性分析,随访其避孕结局。结果 13例SLE患者PAC咨询前长效可逆避孕措施(long-acting reversible contraception,LARC)使用率为0%,其中意外妊娠者11例,2例为计划内妊娠胚胎停育;PAC咨询后有4例患者选择宫内节育系统,2例选择含铜宫内节育器,7例选择男用避孕套,LARC使用率为46.2%;13例患者平均随访(22.6±9.1)月,均未发生意外妊娠,无避孕不良反应、无SLE病情加重;其中有4例获得满意的计划内妊娠。结论 SLE患者的妊娠必须是有计划且高度重视。PAC咨询能明显改善SLE患者避孕观念和促进LARC落实。临床工作者应综合权衡患者个体危险因素及SLE的活动性、抗磷脂抗体状态等,给予最佳的避孕指导。

Objective To discuss the contraceptive methods for women with systemic lupus erythematosus, to give a clinic reference in future contraceptive consultation for women with systemic lupus erythematosus. Methods 13 cases with systemic lupus erythematosus who underwent artificial abortion and PAC consultation in West China Second University Hospital were analyzed retrospectively. Results The utilization rate of LARC is 0 % before PAC consultation. However, 4 patients chose IUS, 2 patients chose IUD, 7 cases chose male condoms, the utilization rate of LARC is 46.2 % after PAC consultation. With an average follow - up of 22. 6±9. 17 months, there were no unexpected pregnancy, contraception adverse reaction and SLE disease progression were found in the 13 patients ;4 patients achieved satisfactory planned pregnancy. Conclusion The pregnancy of patients with SLE must be planned. All women of reproductive age with SLE should be strictly in birth control. Clinicians should consider the patient＇s individual risk factors and SLE activity, aPL state, etc. , to give the best contraceptive consultation.