《2022中国系统性红斑狼疮患者生殖与妊娠管理指南》解读

Interpretation on the 2022 Chinese Guideline for the Management of Pregnancy and Reproduction in Patients with Systemic Lupus Erythematous

系统性红斑狼疮(systemic lupus erythematosus,SLE)多发于育龄期女性,其生育管理已成为SLE患者疾病管理的重要内容。在国家皮肤与免疫疾病临床医学研究中心、国家妇产疾病临床医学研究中心、中国系统性红斑狼疮研究协作组、中国风湿免疫病相关生殖及妊娠研究委员会的联合组织与指导下,制定了我国首部系统性红斑狼疮患者生殖与妊娠管理指南。该指南针对13个亟待解决的临床问题作出基于循证证据的推荐,涵盖了孕前准备(孕前咨询、妊娠风险评估、妊娠时机选择、辅助生育措施选择)、妊娠期疾病监测与治疗、胎儿监测与并发症诊治、产后随访与哺乳注意事项及新生儿监护的母婴全程管理,指南还就SLE患者妊娠的适应证、禁忌证、妊娠过程中一些重要脏器损害的识别与治疗、妊娠与哺乳期药物的使用、妊娠终止的适应证与围妊娠终止期药物的调整、合并抗磷脂抗体综合征患者的诊治等临床关心的重大问题作出了详细推荐,旨在提高SLE患者的妊娠成功率,降低母婴病死率。

Systemic lupus erythematosus(SLE)is an autoimmune disease most prevalent in child⁃bear⁃ing young women.With the progress of treatment,the survival rate of SLE patients has been remarkably im⁃proved.Reproduction management of SLE patients has become one of the most important parts of SLE patients management.However,due to the complicated inter⁃reaction between SLE disease and the related concurrent problems,reproduction management of SLE patients remains a big challenge.Led and guided by the National Clinical Research Center for Dermatologic and Immunologic Diseases,the National Clinical Research Center for Obstetrics and Gynecology,Chinese Systemic Lupus Erythematosus Treatment and Research Group and Chinese Research Committee of Pregnancy and Reproduction in Autoimmune Rheumatic Diseases,the first guideline dedicated to the management of pregnancy and reproduction in patients with systemic lupus erythematous has been developed.This guideline is composed of 13 evidence⁃based recommendations,including pre⁃pregnant preparation(pre⁃pregnant consultation,risk assessment,indications and contraindications for pregnancy and the choices of assisted reproduction technology),monitoring and treatment strategy during pregnancy,monito⁃ring and complications identification and management of the fetus,and recommendations for disease follow⁃up after delivery and feeding of the neonates.These recommendations,covering the whole process of pregnancy of SLE patients,are aimed to improve the success rate of pregnancy of SLE patients and decrease the morbidity and mortality of SLE patients and their fetus.