羟氯喹联合激素治疗妊娠合并系统性红斑狼疮对母婴结局及血清IFN?γ、IL-10影响

The influences of hydroxychloroquine combined with hormone drug on outcomes of maternal and infant,serum IFN-γand IL-10 levels of pregnant women with systemic lupus erythematosus

目的:观察羟氯喹联合激素治疗妊娠合并系统性红斑狼疮对母婴结局及血清γ-干扰素(IFN-γ)、白细胞介素-10(IL-10)的影响。方法 :将92例妊娠合并系统性红斑狼疮患者随机分为两组,对照组46例给予激素治疗,观察组46例给予羟氯喹联合激素治疗。记录患者妊娠期间系统性红斑狼疮活动指数(SLEDAI)评分及母婴结局,检测孕妇妊娠初期和分娩前血清IFN-γ、IL-10水平,观察治疗期间不良反应发生情况。结果:经治疗,观察组和对照组妊娠中期、妊娠末期SLEDAI评分均较妊娠初期降低,且观察组低于对照组,足月妊娠率高于对照组(均P<0.05);两组终止妊娠率、早产率、新生儿窒息率、低体重儿率、新生儿出生体重和出生后5min Apgar评分比较无差异(P>0.05);两组分娩前血清IFN-γ、IL-10水平均较妊娠初期下降,且观察组低于对照组(均P<0.05),治疗期间不良反应发生率两组无差异(P>0.05)。结论:羟氯喹联合激素治疗妊娠合并系统性红斑狼疮,能明显改善患者母婴结局,降低血清IFN、IL-10水平。

Objective: To observe the influence of hydroxychloroquine combined with hormone drug on outcomes of maternal and infant, and serum interferon-γ(IFN-γ) and interleukin-10 (IL-10) levels of pregnant women with systemic lupus erythematosus (SLE). Methods: 92 pregnant women with SLE were randomly divided into two groups.46 pregnant women in control group were treated by hormone drug, and 46 pregnant women in study group were treated by hydroxychloroquine combined with hormone drug. The systemic lupus erythematosus disease activity index (SLEDAI) during pregnancy and the outcomes of maternal and infant of all included pregnant women in both groups were recorded, and the serum levels of IFN-γ and IL-10 of all pregnant women in the first trimester pregnancy and ante partum were detected. The adverse reactions of pregnant women were compared between the two groups during treatment. Results: SLEDAI scores of all pregnant women in the second trimester pregnancy and the last trimester pregnancy were significantly lower than those of pregnant women in the early trimester pregnancy ( P <0.05), and SLEDAI scores of pregnant women in study group were significant lower than those of pregnant women in control group ( P <0.05). The rate of full-term pregnancy of pregnant women in study group was significant higher than that of pregnant women in control group ( P <0.05), but there were no significant different in rates of early termination pregnancy, premature delivery, and neonatal asphyxia, and rate of low birth weight, and the neonatal weight, and Apgar score of newborn at 5 minutes after birth between the two groups ( P >0.05). The serum levels of IFN-γ and IL-10 of all pregnant women before delivery were significant lower than those of all pregnant women in the first trimester pregnancy ( P <0.05), and the serum levels of IFN-γ and IL-10 of pregnant women in study group were significant lower than those of pregnant women in control group ( P <0.05). There was no significant different in the incidence of adverse reactions between the two groups ( P >0.05). Conclusion: Hydroxychloroquine combined with hormone drug for treating pregnant women with SLE can significantly improve outcomes of maternal and infant, and can reduce serum levels of IFN-γ and IL-10.