早发性卵巢功能不全患者赠卵IVF获得妊娠在孕期合并系统性红斑狼疮:1例报告并文献复习

Pregnancy outcome in a woman with premature ovarian insufficiency complicated by systemic lupus erythematosus during pregnancy: a case report

为探讨早发性卵巢功能不全(POI)与免疫因素的关系,对我院生殖中心接诊的1名POI患者通过赠卵成功妊娠后发生系统性红斑狼疮(SLE)的病例进行报告,并结合相关文献,回顾POI病因,讨论SLE与妊娠的相互影响以及POI患者妊娠后合并SLE的临床特点及产科处理,以期为不明原因/免疫因素POI患者孕前处理及妊娠后产科随访提供参考。该病例中,患者确诊卵巢早衰4年,2003年我中心行赠卵IVF成功妊娠。孕11周以颜面部浮肿为首发症状,经免疫学检查、肾脏穿刺活检后确诊为SLE、狼疮性肾炎。综合相关专科意见以及患者意愿,予口服强的松控制狼疮活动,加用阿司匹林、低分子肝素改善胎盘血流,密切监测孕妇各项指标及胎儿生长发育。期间孕妇病情反复,孕晚期出现肝功能损害、胎盘功能下降,B超监测不除外胎儿发育迟缓可能,经全院讨论,择期剖宫产分娩一早产男婴。产后继续专科治疗,随访14年,期间患者复查免疫指标逐渐好转,无狼疮相关表现,考虑SLE临床治愈。其子经新生儿科诊治,其生长发育与同龄人无异。通过病例分析和文献回顾,我们认为免疫因素是POI重要病因,并建议不明原因POI患者孕前完善免疫学检查以保障母胎生命。

We report a case of in vitro fertilization and embryo transfer(IVF-ET) with oocyte donation in a woman with premature ovarian insufficiency(POI) complicated by systemic lupus erythematosus(SLE) during pregnancy.The patient had a diagnosis of POI 4 years earlier and 11 weeks after successful pregnancy by IVF-ET with oocyte donation in 2003,she presented with facial edema,and further examinations confirmed the diagnosis of lupus nephritis.She received treatment with prednisone to control the activity of SLE and aspirin and low-molecular-weight heparin to improve placental blood flow with close monitoring of gravida and fetus throughout pregnancy.The condition of the patient remained unstable during pregnancy,and liver damage and placental circulation disorder occurred in late gestational weeks with suspected intrauterine growth retardation(IUGR) of the fetus.For maternal and fetal safety,the patient received elective caesarean section and delivered a premature boy at 31 weeks of gestation.She subsequently received further medications for SLE and showed good recovery of the immunological parameters and absence of SLE symptoms during the follow-up for 14 years,indicating a clinical cure of SLE.Her son shows normal growth and development.Based on the experience with this case and literature review,we believe that immunological factor is an important cause of POI and thus recommend full immunological examinations in cases of idiopathic POI.