系统性红斑狼疮与孕产妇不良妊娠结局的相关性

Correlation between systemic lupus erythematosus and adverse pregnancy outcomes in pregnant women

目的 探讨系统性红斑狼疮(SLE)与孕产妇不良妊娠结局的相关性。方法 收集2018年6月—2020年5月天津市中心妇产科医院收治的120例SLE合并妊娠患者的临床资料,根据临床妊娠结局分为正常组和不良妊娠组。比较两组人口学资料、SLE疾病活动度、妊娠期合并症、用药情况及实验室指标差异,采用多因素Logistic回归分析SLE与孕产妇不良妊娠结局的相关性。结果 120例SLE妊娠患者中,足月生产55例,早产27例,妊娠丢失38例,不良妊娠发生率为54.17%(65/120)。单因素分析显示:不良妊娠组新发SLE、中重度SLE疾病活动、狼疮肾炎、白细胞减少、淋巴细胞减少、血小板减少、低补体血症、抗β2糖蛋白(+)及狼疮抗凝物(+)比例显著高于正常组(P<0.05),妊娠期应用羟氯喹、糖皮质激素及阿司匹林/低分子肝素比例显著低于正常组(P<0.05)。多因素Logistic回归分析显示:中重度SLE疾病活动、狼疮肾炎、血小板减少、低补体血症及狼疮抗凝物(+)是不良妊娠结局的独立危险因素(P<0.05),妊娠期用药是不良妊娠结局的保护因素(P<0.05)。结论 SLE与孕产妇不良妊娠结局有一定的关联,合理用药可以提高患者妊娠成功率。

Objective To investigate the relationship between systemic lupus erythematosus(SLE) and adverse pregnancy outcomes in pregnant women.Methods The clinical data of 120 SLE patients with pregnancy admitted to our hospital from June 2018 to May 2020 were collected and divided into two groups according to the clinical pregnancy outcome: normal group and adverse pregnancy group. The demographic data, SLE disease activity, pregnancy complications, medication and laboratory indexes were compared between the two groups. The correlation between SLE and maternal adverse pregnancy outcomes was analyzed by multivariate Logistic regression.Results Among 120 patients with SLE pregnancy, 55 cases had full-term production, 27 cases had premature delivery, 38 cases had pregnancy loss, and the incidence of adverse pregnancy was 54.17 %(65/120). Univariate analysis showed that the proportion of newly diagnosed SLE, moderate to severe SLE disease activity, lupus nephritis, leukopenia, lymphocyte reduction, thrombocytopenia, hypocomplementemia, anti-β2 glycoprotein(+) and lupus anticoagulant(+) in the adverse pregnancy group was significantly higher than that in the normal group(P< 0.05), and the proportion of hydroxychloroquine, glucocorticoid and aspirin/low molecular weight heparin during pregnancy was significantly lower than that in the normal group(P<0.05). Multivariate Logistic regression analysis showed that moderate and severe SLE disease activity, lupus nephritis, thrombocytopenia, hypocomplementemia, lupus anticoagulant(+) were independent risk factors for adverse pregnancy outcomes(P<0.05), and medication during pregnancy was a protective factor for adverse pregnancy outcomes(P<0.05).Conclusion SLE is associated with adverse pregnancy outcomes of pregnant women, and rational drug use can improve the success rate of pregnancy.