胎儿脐动脉血流彩色多普勒在系统性红斑狼疮不良妊娠结局的预测作用

Predictive Value of Fetal Umbilical Artery Doppler on Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus

【目的】探讨系统性红斑狼疮(SLE)妊娠患者不良妊娠结局(APO)的发生情况以及胎儿脐动脉血流彩色多普勒预测APO发生的价值。【方法】对2010年至2016年广州中医药大学附属第一医院和中山大学附属第一医院收治的273例SLE合并妊娠临床资料进行回顾性分析。【结果】SLE孕妇妊娠时平均年龄为(29.2±3.7)岁,范围19~40岁。发生APO 169例(169/273,61.9%),包括60例妊娠丢失、56例早产、12例新生儿狼疮、21例胎儿宫内窘迫、20例宫内发育迟缓。共118例患者在妊娠28~34周行胎儿脐动脉血流多普勒彩超检查,其中有APO65例,无APO 44例。合并APO组的搏动指数(1.00±0.25和0.88±0.16,P=0.004)、阻力指数(0.81±0.42和0.59±0.08,P<0.001)、S/D(2.92±0.95和2.30±0.51,P<0.001)均高于未发生APO组。【结论】SLE妊娠易发生APO。胎儿脐动脉血流多普勒彩超检查是晚孕期监测APO的重要无创手段。

【Objective】To explore the adverse pregnancy outcomes(APO)and examine the predictive value of umbilical artery Doppler in systemic lupus erythematosus(SLE)pregnancies.【Methods】Data of273pregnancies from2010to2016were analyzed retrospectively.Pulsatility index(PI),resistance index(RI),and systolic/diastolic ratio(S/D)of the umbilical artery flow velocity data were monitored by Doppler ultrasound.【Results】One or more APO occurred in61.9%of patients with SLE,among which pregnancy loss occurred in60cases;preterm birth in56cases;intrauterine growth retardation occurred in20cases;and fetal distress occurred in21cases.Twelve of pregnancies resulted in neonatal Lupus.In total,118patients underwent fetal umbilical artery Doppler during28~34gestational weeks.Doppler PI,RI,and S/D were significantly higher in the APO groups than in the patients without APO.【Conclusion】Pregnancies in lupus still had an increased risk of APO.Umbilical artery Doppler was useful in predicting APO in lupus pregnancies.