大动脉炎合并妊娠19例临床分析

Clinical analysis of 19 cases of pregnant patients with Takayasu arteritis

目的探讨大动脉炎合并妊娠患者的临床特点和妊娠结局。方法回顾性分析2011年1月至2020年12月北京大学第三医院妇产科收治的19例大动脉炎(TA)合并妊娠患者的临床资料。结果①19例患者年龄24~39岁,中位年龄29.0岁。其中妊娠前诊断17例,妊娠期诊断2例;TA头臂动脉型9例,胸腹主动脉型2例,广泛型8例,后两种类型患者均有肾动脉受累,诊断为大动脉炎性肾动脉炎(TARA)。②19例TA患者中,5例并发子痫前期,3例妊娠期新发高血压,2例慢性高血压病情加重,其中4例产后病情危重转入ICU,无孕产妇死亡。19例TA患者中,4例流产,4例早产,11例足月产;15例TA患者进入围产期,共分娩活产儿15个,平均分娩孕周(37.0±2.6)周;新生儿平均出生体重(2621.3±662.8)g,无新生儿窒息,2例因早产儿转儿科。③TARA患者流产和妊娠期高血压疾病发生率明显高于无肾动脉受累者(P=0.033,P=0.000)。结论TARA患者妊娠期高血压疾病、流产风险增加,是影响TA患者妊娠结局的重要因素。TA患者妊娠前应充分咨询及风险评估,妊娠期通过多科协作,可获得较好的妊娠结局。

Objective To investigate the clinical characteristics and pregnant outcomes of patients with Takayasu arteritis.Methods The clinical data of 19 cases of pregnant patients with Takayasu arteritis(TA)who admitted in Peking University third hospital from 2011 to 2020 were retrospectively analyzed.Results①The patients were 24 to 39 years old,with the median age of 29 years old.17 cases were diagnosed before pregnancy,and 2 cases were diagnosed during pregnancy.There were 9 cases of brachiocephalic artery type,2 cases of thoraco-abdominal aortic type,and 8 cases of extensive type.The latter two types of patients were Takayasu arteritis-induced renal arteritis(TARA).②Among the 19TA patients,5 were complicated with preeclampsia,3 had new-onset hypertension during pregnancy,and 2 with chronic hypertension worsened.Four patients were critically admitted to ICU,with no maternal deaths.Among the 19 TA patients,4were miscarriage,4 were premature delivery and 9 were full-term delivery.A total of 15 live births were delivered from 19TA patients,with the mean gestational age of delivery was(37.0±2.6)weeks and the birth weight of(2621.3±662.8)g.There was no neonatal asphyxia,and 2 cases were transferred to pediatrics due to premature infants.③The incidence of miscarriage and hypertension during pregnancy was significantly higher in TARA patients than in those without renal artery involvement(P=0.033,P=0.000).Conclusions TARA is an important factor affecting the pregnancy outcome.TARA patients have increased risk of hypertension and miscarriage.Patients with TA should be fully consulted and risk assessment before pregnancy,and the condition should be monitored by multiple disciplinaries during pregnancy,so as to obtain a better pregnant outcome.