妊娠合并系统性红斑狼疮38例临床分析

目的 探讨系统性红斑狼疮（SLE）的妊娠时机及妊娠期治疗对SLE妊娠患者母婴结局的影响。方法回顾分析38例妊娠合并SLE患者的妊娠时机及妊娠期处理措施，观察其妊娠期SLE病情变化和妊娠结局。结果21例（55．3％）出现不同程度的病情活动，非选择妊娠者（9／26）SLE病情活动、产科并发症发生率、妊娠丢失率明显高于选择妊娠者，新生儿体质量显著低于选择妊娠者（P〈0．05）。结论妊娠合并SLE患者母体及胎儿相关疾病发生率增高，选择合适妊娠时机及积极控制SLE病情是改善母婴结局的关键措施。     

探讨妊娠期糖代谢异常经过及时诊断和规范处理对母儿预后的影响

目的研究妊娠期糖尿病和糖尿病合并妊娠患者在经过及时诊断处理后,其对母儿结局的影响。方法收集2013年1月—2014年1月期间,在该院诊断并分娩的糖代谢异常妊娠孕妇200例的临床资料,其中包括188例妊娠期糖尿病,12例糖尿病合并妊娠,将这200例孕妇作为研究组。选择同期收治的糖代谢正常的孕妇260名为对照组。对研究组孕妇行临床血糖的控制与处理。结果妊娠期糖尿病组巨大儿发生率为12.70%、妊高征发生率为14.70%,明显高于对照组的7.69%、7.69%,差别有统计学意义（P〈0.05）。糖尿病合并妊娠组孕妇各种并发症的发生率与对照组比较差别无统计学意义（P〉0.05）。结论经过及时诊断和规范处理,妊娠期糖尿病组巨大儿、妊高征发生率仍高于糖代谢正常孕妇;糖尿病合并妊娠孕妇及围生儿结局明显改善。     

系统性红斑狼疮合并妊娠145例次母婴结局及临床预测因素

目的 总结系统性红斑狼疮(SEE)合并妊娠的母婴结局,分析妊娠期问SLE病情恶化、胎儿丢失、不良胎儿结局的预测因素.方法 回顾性分析1990年1月至2007年12月在北京协和医院和深圳市人民医院住院的SEE合并妊娠临床资料.结果 120例SEE合并妊娠145例次,妊娠时年龄18～4I岁,平均(28±4)岁,SEE病程0.5～18年,平均(5±4)年.共有46例次(31.7%)妊娠期间SLE病情恶化,主要在妊娠中、晚期,常累及皮肤黏膜及关节肌肉系统.妊娠期间SEE病情恶化与妊娠前病情活动及低补体血症有关(P＜0.05).妊娠前病情活动组子痫前期及子痫的发生率明显高于病情稳定组(P＜0.01).共成功分娩104例次(71.7%,其中双胞胎2例),18例次自然流产(12.4%),10例次死产(6.9%),13例次治疗性流产(9.0%).早产36例次(34.6%),新生儿出现宫内生长迟缓(IUGR)37例次(35.6%).胎儿丢失(包括自然流产及死产)的危险因素有合并抗磷脂综合征(APS)、妊娠前病情活动(P＜0.05);引起不良胎儿结局(包括早产或IUGR)的危险因素有妊娠前抗dsDNA抗体阳性、泼尼松剂量≥10 mg/d及妊娠期间SLE病情恶化(P＜0.05).21例患者行胎盘病理学检查,其中13例发现胎盘组织血管壁纤维素样坏死、梗死表现,该组患者抗磷脂抗体阳性率明显高于胎盘病理基本健康组(P＜0.05).结论 妊娠前SEE病情活动、低补体血症与SEE妊娠期间SEE病情恶化相关.合并APS、妊娠前病情活动使胎儿丢失的危险性增加,而妊娠前抗dsDNA抗体阳性、泼尼松剂量≥10 mg/d及妊娠期间SLE病情恶化使不良胎儿结局的危险性增加.     

探讨妊娠期糖代谢异常经过及时诊断和规范处理对母儿预后的影响

目的研究妊娠期糖尿病和糖尿病合并妊娠患者在经过及时诊断处理后,其对母儿结局的影响。方法收集2013年1月—2014年1月期间,在该院诊断并分娩的糖代谢异常妊娠孕妇200例的临床资料,其中包括188例妊娠期糖尿病,12例糖尿病合并妊娠,将这200例孕妇作为研究组。选择同期收治的糖代谢正常的孕妇260名为对照组。对研究组孕妇行临床血糖的控制与处理。结果妊娠期糖尿病组巨大儿发生率为12.70%、妊高征发生率为14.70%,明显高于对照组的7.69%、7.69%,差别有统计学意义(P0.05)。糖尿病合并妊娠组孕妇各种并发症的发生率与对照组比较差别无统计学意义(P0.05)。结论经过及时诊断和规范处理,妊娠期糖尿病组巨大儿、妊高征发生率仍高于糖代谢正常孕妇;糖尿病合并妊娠孕妇及围生儿结局明显改善。     

妊娠期高血压综合征合并胎盘早剥的护理体会

目的 总结妊娠期高血压综合征(妊高征)合并胎盘早剥的护理体会。方法 选择2009年7月—2012年7月我院妇产科收治的妊高征合并胎盘早剥产妇22例,回顾性分析孕妇住院期间的护理措施和妊娠结局,总结妊高征合并胎盘早剥产妇的护理经验。结果 22例产妇经住院治疗及护理后,自然分娩6例、剖宫产16例。其中3例产妇出现死胎,8例产妇经治疗后病情基本稳定、生产顺利,1例产妇出现肾衰竭,2例产妇出现弥漫性血管内凝血,5例产妇出现产后出血,3例产妇出现胎儿宫内窘迫。结论 做好各阶段的评估工作、保证病房环境的干净舒心、保证产妇的生理舒适及心理护理能有效改善妊高征合并胎盘早剥产妇的妊娠结局。     

妊娠期高血压综合征合并胎盘早剥的护理体会

目的总结妊娠期高血压综合征(妊高征)合并胎盘早剥的护理体会。方法选择2009年7月—2012年7月我院妇产科收治的妊高征合并胎盘早剥产妇22例,回顾性分析孕妇住院期间的护理措施和妊娠结局,总结妊高征合并胎盘早剥产妇的护理经验。结果 22例产妇经住院治疗及护理后,自然分娩6例、剖宫产16例。其中3例产妇出现死胎,8例产妇经治疗后病情基本稳定、生产顺利,1例产妇出现肾衰竭,2例产妇出现弥漫性血管内凝血,5例产妇出现产后出血,3例产妇出现胎儿宫内窘迫。结论做好各阶段的评估工作、保证病房环境的干净舒心、保证产妇的生理舒适及心理护理能有效改善妊高征合并胎盘早剥产妇的妊娠结局。     

妊娠高血压综合征患者的心律失常研究

目的探讨妊娠高血压综合征患者发生心律失常的类型、原因及其与病情轻重的关系,进一步提高对本病的认识。方法回顾性分析本院1999年1月~2004年11月间经临床诊断为妊娠高血压综合征的344例患者发生心律失常的情况。结果收治的344例妊高征患者有进行心电图检查164例,心电图检查率为47.7%,其中发现有心律失常98例,发生为59.8%。室上性心律失常占67%、室性心律失常占15.3%、房性并室性心律失常占11.8%、各类型传导阻滞占5.9%。窦性心动过速为41.2%,居首位。重度妊高征患者心律失常发生率为79.6%,中度妊高征患者心律失常发生率为31.1%,轻度妊高征患者心律失常发生率为28.6%,重度妊高征患者心律失常发生率与轻度、中度妊高征患者有显著性差异(P<0.005),轻度妊高征患者与中度妊高征患者心律失常发生率无显著性差异(P>0.05)。结论妊娠高血压综合征患者可发生各种类型心律失常,其心律失常的发生与病情轻重有关,临床应重视对妊娠高血压综合征孕产妇进行心电图检测。     

妊娠高血压综合征患者心律失常的发生率及分布特征

目的 描述妊娠高血压综合征（妊高征）患者心律失常发生率及分布特征。方法 选取我院患有妊娠高血压综合征的孕妇280例,观察其生产前后的心电图变化及不同程度妊娠高血压综合征的心电图情况,另抽取280例正常孕妇作为正常孕妇组。结果 妊高征组产前心律失常发生率显著高于产后心律失常发生率（58.2% vs. 20.0%,P<0.05）。妊高征组产前心律失常率与正常孕妇组产前心律失常率比较,差异具有统计学意义（P<0.05）。不同程度妊娠高血压综合征组心律失常率比较,差异均有统计学意义（P<0.05）。结论 妊高征患者产前的心律失常率比产后的心律失常率高,也显著高于正常孕妇组。随着妊高征程度的加重,心律失常发生率依次增高。     

妊娠期高血压综合征的临床护理观察

目的观察妊娠期高血压综合征(简称妊高征)患者的临床护理措施。方法选取我院2014年5月~12月收治的妊高征患者84例作为研究对象,随机分为干预组(在常规护理基础上配合综合护理干预措施)和对照组(单独采用常规护理干预措施),各42例。将两组患者病情转归情况以及母婴结局情况进行对比。结果干预组患者经过护理后妊高征轻中度为90.5%明显高于对照组的71.4%,差异有统计学意义(P0.05)。对照组,先兆子痫6例,子痫3例,胎儿畸形死亡1例,不良母婴结局发生率为23.8%,干预组产妇及新生儿未出现这些不良妊娠结局。结论妊高征患者采用综合护理干预措施,可有效控制患者病情进一步发展,改善母婴分娩结局,提高母婴的存活率,值得在临床上广泛推广。     

5例妊娠期肾病综合征临床资料分析

妊娠期高血压疾病（妊高征）的特殊类型有HELLP综合征和妊娠期肾病综合征。1992年全国妊高征及其并发症的诊断和处理学术研讨会上将妊娠期肾病综合征（nephroticsyndromeofpregnancy，NSP）定为妊高征Ⅲ型。NSP的发病率虽较低，国外Weisman等Ⅲ报道大约为0．04％，国内姚天一报道占分娩总数的0．048％；占妊娠期高血压疾病总数的0．48％，但对母婴的危害大、预后差，孕产妇病死率为2．5％；围生儿病死率为42．23％；人为早产、低出生体重儿发生率增高。随着人们对此疾病的认识及诊断率的提高，发生率有所上升，李乃碍等报道发病率为0．068％，占妊高征总数的0．8％。     

Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia

The aim of this study was to examine the pregnancy outcomes in patients with systemic lupus erythematosus (SLE) and the effect of SLE flare and treatment on pregnancy outcomes. We performed a retrospective evaluation of all pregnancies occurring in patients with SLE during the 27-year period from 1980 to 2006. Of the 319 women with SLE planning pregnancy after SLE onset, 176 (55.2%) conceived resulting in 396 pregnancies. Live births were significantly lower in proportion (70.2% vs. 85.7%) and more likely to end in fetal deaths (29.7% vs. 14.2%) and preterm births (26.7% vs. 5.8 %) in pregnancies occurring after SLE onset than in pregnancies occurring before SLE onset (p < 0.0001). With respect to different disease manifestations, we found that fetal loss was significantly higher in patients with antiphospholipid (aPL) antibodies than without (p < 0.001). Preterm deliveries were significantly more frequent in patients with lupus nephritis, anti-Ro/SSA antibodies, hypertension, history of intravenous cyclophosphamide treatment and aPL than those without these features (p < 0.05). Neonates with intrauterine growth retardation (IUGR) neonates were more common in hypertensive and Raynaud's-positive pregnancies (p < 0.05). SLE flares occurred in 30.8% pregnancies. There was increased risk of fetal loss, preterm births and IUGR in pregnancies with SLE exacerbations than without (p < 0.05). Prednisolone was found to improve the rate of live births, although it was also a predictor of prematurity. The predictors of pregnancy loss were lupus nephritis (odds ratio (OR) 7.3), aPL (OR 3.9), and SLE flares in pregnancy (OR 1.9). There was higher risk of preterm deliveries in patients with lupus nephritis (OR 18.9), anti-Ro antibodies (OR 13.9), hypertension (OR 15.7) and SLE flares (OR 2.5). IUGR was found to be associated with hypertension (OR 37.7), Raynaud's (OR 12.3), and SLE flares (OR 4.2). In conclusion, pregnancies in SLE patients with active lupus nephritis, anti-Ro/SSA antibodies, aPL, hypertension, Raynaud's phenomenon, active disease at conception and SLE exacerbations are at a higher risk of adverse pregnancy outcomes. It is important to carefully plan pregnancy, and experienced rheumatologists and obstetricians should monitor SLE patients in pregnancy and postpartum.     

Pregnancy rates and perinatal outcomes in women with systemic lupus erythematosus: data from the Korean national health claims database

Introduction/Objectives

The pregnancy rate in systemic lupus erythematosus (SLE) is not fully understood and comparisons of adverse pregnancy outcomes (APOs) with SLE versus the general population are limited. This study aimed to estimate the pregnancy rate and APOs in Korean SLE compared to those without SLE.

Method

Pregnant women were identified using the ICD-10 codes for delivery and abortion in the Korean national health claims database (2013–2015). APOs were classified as fetal loss, intrauterine growth retardation (IUGR), pre-eclampsia/eclampsia, and gestational diabetes. Annual incidence rates (IRs) of pregnancy and APOs were calculated in women with SLE and the general population without SLE and the two groups were compared using age-adjusted incidence rate ratios (IRRs). Age-stratified IRRs were further analyzed.

Results

The annual IRs of pregnancy in SLE were 29.54–30.70 per 1000 persons. The IRRs were lower in women with SLE than in the general population: 0.68 (0.61–0.76), 0.66 (0.60–0.74), and 0.74 (0.66–0.82) in each respective year. The IRRs of fetal loss, IUGR, and pre-eclampsia/eclampsia were 1.30 (1.14–1.49), 4.65 (3.55–6.09), and 3.43 (2.70–4.36), respectively. However, the IRR of gestational diabetes in SLE did not significantly differ from that of women without SLE. Among the APOs, fetal loss, IUGR, and pre-eclampsia/eclampsia showed decreasing tendencies as age increased.

Conclusions

Pregnancy rates in SLE were approximately 30% lower than those in the general population. Except for gestational diabetes, fetal loss, IUGR, and pre-eclampsia/eclampsia were higher in SLE and showed a decreasing tendency with age.

The effect of pregnancy on lupus nephritis

OBJECTIVE: To evaluate the effect of pregnancy on lupus nephritis with respect to renal activity and renal deterioration. METHODS: Seventy-eight pregnancies occurred in 53 women with systemic lupus erythematosus (SLE) and renal disease. Seventy-eight nonpregnant SLE patients with evidence of renal disease were matched to the study population by age at the time of each pregnancy and by the presence of a renal manifestation at the beginning of the study. The nonpregnant controls were seen within 2 years of the assessment dates of the pregnant patients with whom they were matched. Renal activity was defined as the presence of active urine sediment or proteinuria, and changes in these parameters were monitored throughout the study period in both study populations. Renal deterioration was defined as an increase in the serum creatinine level that was >20% above the baseline value or an increase to >120 mmoles/liter. RESULTS: Renal disease activity patterns were available for 74 pairs of pregnancies and controls. Renal disease became active during the study period in 33 pregnancies (44.6%) and 31 controls (41.9%). Serial serum creatinine levels were available for 75 study pairs, among which 62 pregnancies (82.7%) and 57 controls (76.0%) showed no deterioration. Comparison of the treatments received by both the pregnant and the nonpregnant patients showed no significant difference in the amount of steroids taken. A significantly lower amount of immunosuppressive and antimalarial agents were taken during the pregnancies. CONCLUSION: During pregnancy in patients with SLE and renal disease, changes in renal disease activity and deterioration in renal function are similar to those which occur in nonpregnant patients with lupus nephritis.     

乌拉地尔治疗重度妊娠高血压综合征的疗效及安全性

目的　探讨乌拉地尔对重度妊娠高血压综合征的临床疗效及安全性。方法　 132例重度妊高征患者随机分为两组 ,分别给予乌拉地尔和酚妥拉明治疗。两组均予持续心电监护和血压监测 ,在治疗开始前半小时内每 5min 1次 ,以后每小时 1次记录血压、心率的变化 ,并观察不良反应。结果　治疗组总有效率97 0 % ,起效时间为 ( 4 2± 2 8)min ,症状改善时间为 ( 2 6 6± 8 8)min ,与对照组的 95 5 % ,( 3 9± 2 6 )min ,( 38 7± 13 5 )min相比 ,前二者无显著性差异 (P >0 0 5 ) ,后者有显著性差异 (P <0 0 5 )。两组治疗后血压较治疗前均有显著下降 (P <0 0 5 ) ,治疗组心率改变不明显 ,对照组用药后 30min～ 2h心率加快 ,与用药前比较差异显著 (P <0 0 5 ) ,至用药后 4h才恢复用药前水平。治疗组降压平稳 ,未发现严重不良反应。结论　乌拉地尔治疗重度妊高征起效快 ,降压平稳 ,安全性高。     

Decreased baroreflex sensitivity is linked to sympathovagal imbalance,low-grade inflammation,and oxidative stress in pregnancy-induced hypertension

Pregnancy-induced hypertension (PIH) has been reported as a cardiovascular (CV) risk. We assessed the sympathovagal imbalance (SVI) and the association of inflammation and oxidative stress (OS) with CV risks in PIH. A total of 125 pregnant women having a risk factor for PIH were followed till term and the incidence of PIH was observed. Retrospectively, they were divided into two groups: Group I (those who did not develop PIH, n = 82) and Group II (those who developed PIH, n = 43). Blood pressure variability (BPV) parameters including baroreflex sensitivity (BRS), spectral heart rate variability (HRV), autonomic function tests (AFTs), inflammatory markers (interleukin-6, TNF-α, interferon-γ), and OS markers were measured in both the groups. Alterations in parasympathetic and sympathetic components of AFTs were analyzed. Link of various parameters to BRS was assessed by correlation and multiple regression analysis. Parasympathetic components of AFTs were decreased from the early part of pregnancy and sympathetic components were increased toward the later part of pregnancy. Decreased BRS, the marker of CV risk, was more prominent in Group II subjects. Independent contribution of interleukin-6 (β = 0.276, P = 0.020), TNF-α (β = 0.408, P = 0.002), interferon-γ (β = 0.355, P = 0.008), and thiobarbituric-acid reactive substance (β = 0.287, P = 0.015) to BRS was found to be significant. It was concluded that sympathetic overactivity that develops more in the later part (third trimester) of pregnancy contributes to SVI and genesis of PIH. In PIH women, CV risks are present from the beginning of pregnancy that intensifies in the later part of pregnancy. Retrograde inflammation and oxidative stress contribute to the decreased BRS in PIH.     

Serum Beta‐Trace Protein as a Novel Predictor of Pregnancy‐Induced Hypertension

Beta‐trace protein (BTP) has emerged as a novel biomarker of cardiovascular risk. However, the level of circulating BTP in pregnancy‐induced hypertension (PIH) is still unknown. The aim of this study was to determine the concentration of serum BTP in healthy pregnant women and patients with PIH. No significant difference was found in the serum concentration of BTP in patients with a normal pregnancy. In contrast, serum BTP levels in women with PIH (n=46) were significantly higher than those in women with normal pregnancy (n=57). Receiver operating characteristic analysis revealed that using a serum BTP value of 321.3 ng/mL as a cutoff produced a sensitivity of 91.3% and a specificity of 89.5%. Taken together, these findings suggest that a higher serum BTP concentration in PIH patients compared with those with normal pregnancy and serum BTP might be a novel biomarker in the diagnosis of PIH.     

Thyroid disease in pregnant women with systemic lupus erythematosus: increased preterm delivery

Thyroid disease is common in pregnancy and is associated with miscarriage, preterm delivery and postpartum thyroiditis (PPT). Systemic lupus erythematosus (SLE) is associated with miscarriage and preterm delivery. The hypotheses of the study are (1) pregnant women with SLE will have a high prevalence of undiagnosed hypothyroidism and a high prevalence of PPT, and (2) women with SLE and thyroid disease will have an increased incidence of adverse pregnancy outcomes as compared with pregnant women with SLE who do not have thyroid disease. This was a retrospective study of the Hopkins Lupus Cohort. All women had thyroid-stimulating hormone and thyroid antibodies assayed on frozen sera. In total, 63 pregnant women who met the ACR classification for SLE were evaluated. Outcome measures were the prevalence of thyroid disease during pregnancy and postpartum, and pregnancy outcomes. Some 13% of the women were on thyroid hormone prior to becoming pregnant, 11% were diagnosed with hypothyroidism during pregnancy, and 14% developed PPT. The prevalence of preterm delivery was 67% in women with thyroid disease and 18% in women who were thyroid disease free (p?=?0.002). The presence of thyroid antibodies was not correlated with preterm delivery. Pregnant women with SLE have an increased prevalence of thyroid disease. Women with SLE and thyroid disease have an increased prevalence of preterm delivery.     

Sodium transport inhibitors in pregnancy-induced hypertension

In blacks and whites of similar socioeconomic background, the incidence of pregnancy-induced hypertension (PIH) is probably the same. In underdeveloped coutries, however, PIH is often a life-threatening complication of pregnancy. Recent theories as to the etiology of PIH include the suggestion that vascular tone may be increased as a result of inhibition of active sodium transport in vascular smooth muscle. This may be the result of an inhibitor of sodium transport present in the serum. The literature concerning the demonstration of endogenous sodium transport inhibitors and endogenous digoxinlike immunoreactivity (EDLI) in PIH is reviewed and discussed.     

Spectral Analysis of Heart Rate Variability for Early Prediction of Pregnancy-Induced Hypertension

The early prediction of pregnancy-induced hypertension (PIH), a common morbid disorder of pregnancy is unsatisfactory. Therefore, in the present study we have investigated the role of spectral analysis of heart rate variability (HRV) in the early prediction of PIH. Spectral analysis of HRV was performed in three groups of subjects (Group I: normal pregnant women; Group II: pregnant women with risk factors, but did not develop PIH; Group III: pregnant women with risk factors and developed PIH). It was observed that the LF-HF ratio, the most sensitive indicator of sympathovagal balance, was significantly high (p < 0.01) since early pregnancy in group III compared to other groups, which was significantly correlated with heart rate and blood pressure. It was suggested that the predictive knowledge of sympathovagal imbalance should be utilized in designing the prevention and management of PIH.