系统性红斑狼疮合并妊娠的回顾性分析

Retrospective Clinical Analysis of Pregnant Patients With Systemic Lupus Erythematosus

【目的】探讨系统性红斑狼疮(SLE)合并妊娠孕妇孕期病情变化以及对妊娠结局的影响,分析不良妊娠结局的相关危险因素。【方法】回顾性分析2013年1月1日至2018年12月31日在中山大学附属第三医院产检并分娩,且病例资料完整的合并SLE孕妇,共89例孕妇,95次妊娠,分析孕期SLE病情活动情况及妊娠结局,找出不良妊娠结局的相关危险因素。【结果】①根据SLE疾病活动指数(SLEDAI)评价病情变化,将其分为疾病活动组及稳定组,其中孕期出现病情活动39例(活动组,A组),病情稳定56例(稳定组,B组),狼疮活动率为41.05%,其中妊娠期初发病例和孕前病情不清非计划妊娠的患者中为100%(17/17),在孕前病情稳定计划妊娠的患者中为28.21%(22/78),差异有统计学意义(P<0.05);②不良妊娠结局:其中胎儿丢失、早产、胎儿宫内生长受限(IUGR)、子痫前期、活动性狼疮肾炎在活动组发生率分别为20.51%、35.90%、43.59%、17.95%、41.02%,稳定组分别为1.8%、14.29%、17.86%、3.57%、0,两组相比差异有统计学意义(P<0.05),胎儿窘迫、新生儿窒息、新生儿狼疮在活动组发生率分别为10.26%、7.69%、2.56%,稳定组分别为1.79%、1.79%、0,两组相比差异无统计学意义(P>0.05);③孕前SLE病情不清非计划妊娠、此次妊娠发生活动性狼疮肾炎、aPL阳性、抗SSA阳性均为不良妊娠结局的危险因素(P<0.05)。【结论】SLE患者妊娠时机的选择对孕期疾病活动情况至关重要,孕期SLE病情活动增加胎儿丢失、早产、IUGR、子痫前期、活动性狼疮肾炎的发生率;孕前SLE病情不清非计划妊娠、此次妊娠发生活动性狼疮肾炎、aPL阳性、抗SSA阳性与不良妊娠结局密切相关。

【Objective】To study the impact of lupus flares on pregnancy outcomes in pregnant patients with systemic lupus erythematosus(SLE),and analyze the risk factors of adverse pregnancy outcomes.【Methods】Data were obtained from 95 pregnancies of 89 patients with SLE between January 1,2013 and December 31,2018 at The Third Affiliated Hospital of Sun Yat-sen University and its Lingnan Branch.The relationship between lupus flares and pregnancy outcomes,and the risk factors for adverse pregnancy outcomes were analyzed.【Results】①The disease changes were evaluated by SLEDI and divided into two groups.Lupus flares occurred in 39 pregnancies(group A),and stable lupus disease was observed in 56 pregnancies(group B).The activity rate of lupus flares was 41.05%,compared with pregnancies in patients with stable lupus disease before pregnancy,pregnancies in patients with first onset pregnancy and unplanned pregnancy before pregnancy had higher lupus flares during pregnancy(100%vs.28.21%,P<0.05).②Adverse pregnancy outcomes:the incidence of fetal loss,preterm labor,intrauterine growth retardation,preeclampsia and active lupus nephritis in group A was 20.51%,35.90%,43.59%,17.95%and 41.02%,respectively,which was significantly higher than those of the group B(1.8%,14.29%,17.86%,3.57%and 0,respectively)(P<0.05).There was no difference in fetal distress,neonatal asphyxia and neonatal lupus between the two groups(10.26%vs.1.79%,7.69%vs.1.79%,2.56%vs.0,respec?tively;P>0.05).③The Logistic regression analysis showed that unplanned pregnancy before pregnancy,active lupus nephritis during pregnancy,aPL positive and antiSSA positive were risk factors for adverse pregnancy outcomes(P<0.05).【Conclusions】Conception timing for pregnant women is crucial to lupus flares during pregnancy.Lupus flares during pregnancy increase the incidence of fetal loss,preterm labor,intrauterine growth retardation,preeclampsia and active lupus nephritis.Unplanned pregnancy before pregnancy,active lupus nephritis during pregnancy,aPL positive and antiSSA positive are associated with adverse pregnancy outcomes.