小剂量丙种球蛋白治疗狼疮妊娠合并抗磷脂综合征患者的疗效观察

目的 系统性红斑狼疮（SLE）妊娠患者合并抗磷脂综合征(APS)时会出现病态妊娠，本研究针对轻 中度活动SLE合并APS患者使用小剂量丙种球蛋白（IVIG）治疗，观察患者及其胎儿的预后。方法 SLE妊娠患者60例，随机分为对照组和观察组，观察组除常规治疗外，接受丙种球蛋白静脉滴注，每月1次10 g，直到生产为止；对照组行常规治疗方法，观察妊娠结局，患者病情，胎儿状况。结果 两组在入组时年龄、患者疾病活动指数（SLEDAI）、抗核抗体（ANA）、抗双链DNA（抗ds DNA）抗体阳性例数、抗β2GPI（抗β2GPI）阳性例数、抗心磷脂抗体（ACA）亚型、既往发生病态妊娠人次差异均无统计学意义，但与对照组比较，观察组补体（C3）降低（P=0.02）。妊娠期间产科并发症比较：观察组妊高症、胎儿窘迫发生率少于对照组（P＜0.05），而两组子痫、胎膜早破、羊水过少的发生率差异无统计学意义（P＞0.05）；但观察组孕妇选择顺产的比例高于对照组，对照组剖宫产比率高于观察组（P＜0.05），观察组免疫抑制剂减量使用例数多于对照组（P＜0.05）；且观察组的新生儿Apgar评分＞7分的较对照组多（P＜0.05）；妊娠期间观察组SLEDAI评分整体较对照组更低，更快稳定；但观察组母乳喂养率较对照组高（P＜0.05）。结论 常规治疗联合小剂量丙种球蛋白对SLE合并APS患者提高妊娠保有率，减少妊娠合并症、产后并发症为行之有效的治疗手段。

Low dose gamma globulin in treatment of pregnants with systemic lupus

Objective Pregnants of systemic lupus erythematosus(SLE) with anti phospholipid syndrome(APS) may present morbid pregnancies, this study aimed for the mild and moderate activity patients with small doses of immunoglobulin G (IVIG) preventive treatment to observe the prognosis of patients and their fetus. Methods Sixty cases of SLE pregnant women were randomly divided into control group and observation group. The observation group received gamma globulin 10 g once a month in addition to regular treatment until the production; observation was performed in pregnancy outcome, patients’ condition, fetal physical condition. Results There was no difference in general information except the complement (C3) at enrolling. The incidence of pregnancy induced hypertension and fetal distress was lower in observation group than in control group (P<0.05). But the incidence of eclampsia, premature rupture of membranes, and oligohydramnios C3, anti ds DNA antibody positive cases, anti β2 GPI positive cases, ACA IgA/IgM，bleeding, abortion, premature delivery, intrauterine fetal malformations， in the incidence of atrioventricular block, rash, low birth weight, and Apgar scores 4 7 points in newborns, the occurrence of intrauterine infection, poor healing of cesarean section wounds, changes in hormone immunosuppressive drug use, and incidence of new infantile diseases and deaths showed no significant difference between two groups (P>0.05). However, in observation group, the proportion of pregnant women who chose to deliver was higher than that of control group. The SLEDAI score of observation group during pregnancy was lower than that of control group. The breastfeeding rate was higher in observation group than in control group (P<0.05). Conclusion Low dose gamma globulin can improve the success rate of pregnancy and reduce pregnancy complications and postpartum complications in patients with SLE and APS.