系统性红斑狼疮肾炎对妊娠结局影响的Meta分析

Meta-analysis of pregnancy outcomes in patients with lupus nephritis

(1)目的系统评价妊娠合并狼疮肾炎患者不同病情对妊娠结局的影响。(2)方法检索CNKI数据库、万方数据库、中国生物医学文献数据库、Pubmed、EMBAS、OVID等数据库,收集1998~2017年公开发表的妊娠合并狼疮肾炎对妊娠结局影响的病例进行回顾性分析,对妊娠合并狼疮肾炎患者不同病情对妊娠结局的影响进行Meta分析。(3)结果最终纳入10个病例对照研究507个受试者的540次妊娠。Meta分析结果显示母体的不良妊娠结局:(1)在病情恶化方面,活动性狼疮肾炎妊娠患者与非活动性狼疮肾炎妊娠患者比较差异有统计学意义(OR=2.04,95%CI=1.21~3.45,P<0.01);(2)在高血压发生率方面,活动性狼疮肾炎妊娠患者与非活动性狼疮肾炎妊娠患者比较差异无统计学意义(OR=1.15,95%CI=0.32~4.09,P=0.83);(3)在子痫前期发生率方面,活动性狼疮肾炎妊娠患者与非活动性狼疮肾炎妊娠患者比较差异有统计学意义(OR=2.62,95%CI=1.36~5.05,P<0.01)。胎儿的不良妊娠结局:(1)在胎儿丢失方面,活动性狼疮肾炎妊娠患者与非活动性狼疮肾炎妊娠患者比较差异有统计学意义(OR=4.90,95%CI=1.54~15.59,P<0.01);(2)在治疗性流产方面,活动性狼疮肾炎妊娠患者与非活动性狼疮肾炎妊娠患者比较差异有统计学意义(OR=5.45,95%CI=3.08~9.64,P<0.001);(3)在早产方面,活动性狼疮肾炎妊娠患者与非活动性狼疮肾炎妊娠患者比较差异有统计学意义(OR=4.26,95%CI=2.19~8.31,P<0.001)。(4)结论系统性红斑狼疮肾炎患者,非活动期妊娠与活动期妊娠相比可获得较好的母婴结局。

Objective The influence of different conditions on pregnancy outcome in pregnancy complicated with lupus nephritis is systematically evaluated.Methods We searched the CNKI database,Wanfang database,Chinese biomedical literature databases,Pubmed,EMBAS and OVID database,collected the retrospective analysis concerning the influence of different conditions on pregnancy outcome in pregnancy complicated with lupus,published from 1998 to 2017.The influence of different conditions on pregnancy outcome in pregnancy complicated with lupus nephritiswas analyzed by Meta.Results Ten studies with 507 patients and 540 pregnancies were included.Meta analysis showed that:Maternal adverse pregnancy outcomes included:①There was statistical significance in the rate of deteriorate of patients'condition between the pregnant patients with active lupus nephritis and those with inactive lupus nephritis(OR=2.04,95%CI=1.21~3.45,P<0.01);②There was no statistical significance in the rate of hypertension between the pregnant patients with active lupus nephritis and those with inactive lupus nephritis(OR=1.15,95%CI=0.32~4.09,P=0.83);③There was statistical significance in the rate of preeclampsia between the pregnant patients with active lupus nephritis and those with inactive lupus nephritis(OR=2.62,95%CI=1.36~5.05,P<0.01).Fetal adverse pregnancy outcomes included:①There was statistical significance in the rate of fetal loss between the pregnant patients with active lupus nephritis and those with inactive lupus nephritis(OR=4.90,95%CI=1.54~15.59,P<0.01);②There was statistical significance in the rate of therapeutic abortion between the pregnant patients with active lupus nephritis and those with inactive lupus nephritis(OR=5.45,95%CI=3.08~9.64,P<0.001);③There was statistical significance in the rate of premature birth between the pregnant patients with active lupus nephritis and those with inactive lupus nephritis(OR=4.26,95%CI=2.19~8.31,P<0.001).Conclusion Compared with active lupus nephritis,the pregnant patients with inactive lupus nephritis can achieve better maternal and fetal outcomes.