妊娠合并系统性红斑狼疮的诊治进展

正"红斑狼疮"一词最早是由内科医生提出的,用于描述皮肤病损。经过一百多年的探索,学者们逐渐认识到系统性红斑狼疮(systemic lupus erythematosus, SLE)是一种全身性的自身免疫性疾病,几乎可以导致每个器官的损害。SLE一般发病于育龄期女性,大多数SLE患者可以成功妊娠,但因其潜在的母胎并发症,因此妊娠合并SLE患者应被当作高危产科人群进行管理[1]。多年来国内外产科、风湿免疫科及药学专家发表了许多高质量研究成果、     

妊娠合并血小板减少61例临床分析

目的 :探讨妊娠合并血小板减少的病因和围产期的处理方法。方法 :回顾分析 6 1例妊娠合并血小板减少患者的临床资料。结果 :6 1例血小板减少的病因为再生障碍性贫血、特发性血小板减少性紫癜 (ITP)、脾功能亢进、系统性红斑狼疮 (SLE)、抗心磷脂抗体综合征、妊娠高血压综合征及妊娠期肝内胆汁淤积症 (ICP)。治疗方法是使用糖皮质激素、免疫球蛋白与成分输血等。早产 15例 ,阴道分娩 10例 ,剖宫产 5 1例。结论 :妊娠合并血小板减少处理的重点是治疗合并症和并发症 ,加强监护 ,适时提升血小板数 ,防止分娩期出血     

妊娠合并系统性红斑狼疮7例临床分析

目的:明确妊娠与系统性红斑狼疮(SLE)间的相互影响,探讨对妊娠合并高血压或蛋白尿患者中SLE的早期识别、诊断与治疗方法.方法:对近8年来我院7例妊娠合并SLE的高危患者进行回顾分析,观察其病情演变与治疗间的关系.结果:4例妊娠后初发SLE患者均伴有血压升高及尿蛋白阳性,其中3例患者病情危重(死亡1例),足月分娩1例,早产3例(死亡1例).3例妊娠前确诊患者,其中1例控制期患者合并有高血压;2例缓解期患者中1例合并有蛋白尿,但病情均平稳,3例均足月分娩,1例为小于胎龄儿.结论:妊娠可诱发或加重SLE.妊娠后初发的患者妊娠结局差,合并高血压及蛋白尿预后较差;SLE控制期和缓解期妊娠预后较好.应加强妊娠合并高血压或蛋白尿患者中SLE的早期识别、诊断及相应治疗.     

妊娠和系统疾患

不少系统疾患好发于育龄妇女,如急、慢性肾炎、系统性红斑狼疮、甲状腺疾患等,这些疾患有时对妊娠可有一定影响;反之,妊娠、分娩对这类疾患也会产生程度不一的影响。有系统疾患的妇女是否可以妊娠;怎样才能使妊娠顺利胎儿健康产妇原有的系统疾患不恶化?这些是令人关注的问题,笔者就此内容,收集近年来国外有关文献综述如下。系统性红斑狼疮包括已确诊和疑似病例在内,系统性红斑狼疮(SLE)的罹患率约为50～100/百万人,其中确诊者占48.5%,男女的比为1∶     

妊娠合并系统性红斑狼疮的诊治

系统性红斑狼疮(SLE)患者合并妊娠时,可使SLE病情复发或恶化,同时SLE亦会增加妊娠合并症,并对胎儿产生不良影响。因此,对于有生育要求的SLE患者须选择适当的妊娠时机,孕期接受严密的监护和适当的治疗,方能获得良好的妊娠结局。现本文就妊娠合并系统性红斑狼疮的诊断及治疗方法做一阐述。     

妊娠合并系统性红斑狼疮与不良妊娠结局

系统性红斑狼疮（SLE）是好发于育龄期女性的自身免疫性结缔组织病。系统性红斑狼疮患者发生不良妊娠结局的风险高达19.0%～70%。妊娠合并SLE常见的不良妊娠结局包括狼疮复燃、流产、早产、子痫前期、胎儿生长受限、新生儿狼疮等。当SLE同时伴有特异性抗体如抗磷脂抗体时,不良妊娠结局的发生风险上升28.4%;伴有Ro/La抗体时,胎儿、新生儿先天性心脏传导阻滞发生率为1%～2%。SLE缓解期在医生指导下计划妊娠、孕期严密监测、个体化及多学科管理是改善不良妊娠结局的关键。     

妊娠合并系统性红斑狼疮

系统性红斑狼疮(以下简称SLE)属自身免疫性疾病,妊娠、分娩能否造成SLE病情的恶化、缓解抑或全无影响,目前观点不一。多数学者认为,妊娠、分娩是导致SLE恶化的因素。SLE病情恶化的时期多为妊娠14周左右,分娩后病情恶化多数较重,少数病例亦可在妊娠早、中期缓解。病情恶化的征候有发热、皮肤红斑、水肿、关节疼痛、胸膜炎、心包炎等浆膜炎及眼、中枢神经系统症状等。实验室检查可见血沉加快,贫血加重,LE(红斑狼疮)细胞阳性,抗核抗体增高,尿蛋白、红细胞及肾功能异常等。     

妊娠合并系统性红斑狼疮研究进展

系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种好发于年轻妇女的可累及多器官、多系统的自身免疫性疾病。妊娠合并SLE容易引起不良妊娠结局。本文就妊娠合并SLE的妊娠时机及孕期监测、终止妊娠时间、产后监测等方面进展进行总结。     

妊娠合并妇科恶性肿瘤分娩方式的选择

在正常妊娠的情况下,分娩的方式可分为两类:自然生产和剖宫产。产妇和胎儿都具有潜力能主动参与并完成生产过程,而且绝大多数都可以以自然生产而告终,剖宫产是一种万不得已的分娩方式。在合并妇科恶性肿瘤时,选择分娩方式便成为关注的重点,而恶性肿瘤患者妊娠后的生理及生育问题需要妇科与产科医生携手共同解决。本文就妊娠合并妇科恶性肿瘤晚期妊娠时的分娩方式选择加以整理,以供同道借鉴。威胁女性生殖健康的妇科恶性肿瘤约占整个肿瘤数的1/5,而此类患者合并妊娠少见,发生于年青女性的肿瘤,主要是宫颈癌、卵巢癌[1-2]。1合并宫颈癌分娩方…     

系统性红斑狼疮与妊娠(附13例临床分析)

1980～1989年收治妊娠合并系统性红斑狼疮(SLE)13例,其中肾炎型10例,皮肤关节型1例,其他型2例.妊娠期恶化10例.13例中至妊娠晚期8例,6例分娩活婴,其中早产儿4例,早产儿中,3例体重小于胎龄.妊娠结果表明,活动性 SLE 对母儿有明显的损害,以肾炎型及较严重的心、肺、浆膜炎者(其他型)为著.本文对妊娠期 SLE 病情变化的因素进行了讨论.     

Changes in beta-endorphin in fetal membranes and placenta in normal and pathological pregnancies

Several studies indicated that trophoblast tissue synthesizes pro-opiomelanocortin-related peptides. These peptides are also present in amniotic fluid, but their origin remains unknown. The present study evaluated the presence of and the possible changes in beta-endorphin (beta-EP) in amnion and chorion during pregnancy, at parturition and in spontaneous abortion. Amnion, chorion and placental tissues were isolated and homogenized from a total of 46 pregnant women between 4th and 42 th week of pregnancy. Beta-EP was separated on a Sephadex G-75 column and measured by RIA with specific antiserum. The identity of the endogenous opioid with its corresponding reference molecule was confirmed by high performance liquid chromatography. In all tissues, the concentration of beta-EP in the first trimester was significantly higher than in the second trimester. A negative correlation between opioid levels and gestational age was observed in the first two trimesters. At delivery, the beta-EP content of all tissues was greater than in the second trimester. In tissues collected at term, in the absence of labor, beta-EP levels were very low in comparison with those collected after vaginal delivery. Low beta-EP contents were found in membranes collected from spontaneous abortion in 1st trimester. From these data one can surmise the existence of a local endogenous opioid system in fetal adnexes. This system seems sensitive to the stress of vaginal delivery and could be involved in the mechanisms leading to spontaneous abortion.     

Differences in preterm delivery rates and outcomes in Jews and Bedouins in Southern Israel

OBJECTIVE: (1) To compare the preterm delivery rates in the Bedouin versus the Jewish population. (2) To compare risk factors for preterm delivery in the two populations. (3) To compare outcomes of preterm delivery between the two groups. STUDY DESIGN: 41669 Jewish singletons births of whom 2816 delivered preterm (23-36 weeks) and 26495 Bedouin singletons in whom 2064 preterm deliveries occurred, were compared. All births took place in Soroka University Medical Center. Data were obtained from the computerized database of birth discharge records. RESULTS: The incidence of preterm delivery in Bedouin women was significantly higher than the rate in Jewish women (7.8 vs. 6.8%, P<0.01). The grand multiparity rate was higher among Bedouin women (P<0.001), as was the rate of teenage (<19 years) mothers (P<0.001). Gestational diabetes, PIH, and PROM rates were higher in the Jewish population (P<0.001, P=0.017, P<0.001, respectively). A bad obstetric history and previous perinatal mortality is more common in the Bedouin population (P<0.001 for both). In a logistic regression model including all these factors, the ethnic difference in the incidence of preterm delivery remained significant. The neonatal mortality rate was higher in the Bedouin population (P<0.001), as was the rate of congenital malformations (P<0.001). The perinatal mortality of Bedouins was nearly twice that of Jewish neonates with congenital malformations. However, no difference was found when neonates without congenital malformations were compared. Congenital malformations were found to be the strongest predictor of mortality. Ethnicity per se was no longer a predictor of mortality once congenital malformations were included in a logistic regression model, but the interaction of Bedouin ethnicity and congenital malformation was a significant predictor of mortality. CONCLUSION: The incidence of preterm delivery was significantly higher in Bedouin women than in Jewish women. A full explanation for this difference was not found. However, there were significantly higher rates of congenital malformations in the Bedouin preterm delivered infants. There was a much higher rate of neonatal mortality in the Bedouin population and this ethnic difference was fully explained by the presence of congenital anomalies.