系统性红斑狼疮患者合并妊娠的临床研究

目的 探讨系统性红斑狼疮(SLE)患者妊娠的安全性、妊娠结局及对子代的影响.方法 回顾性分析1999年6月至2009年10月我院收治的SLE合并妊娠的患者的妊娠情况,比较选择性妊娠和非选择性妊娠组患者的SLE疾病活动情况、产科并发症情况、胎儿情况.并对SLE患者的子代进行随访.统计学处理采用x2检验和t检验.结果 SLE合并妊娠的患者共62例,选择性妊娠组43例,非选择性妊娠组19例;选择性妊娠组中10例(23%)患者在妊娠过程中出现疾病活动,8例(19%)流产,35例(81%)活胎分娩,其中低体质量儿7例,早产7例;非选择性妊娠组中16例(84%)出现疾病活动,13例(68%)流产,6例(32%)活胎分娩,均为低体质量儿,4例早产,3例合并胎儿生长受限.选择性妊娠组的妊娠过程中疾病活动率、流产率均显著低于非选择性妊娠组(P＜0.05).22例子代随访未发现SLE患儿.结论 选择性妊娠组与非选择性妊娠组患者均面临妊娠过程中SLE疾病活动及妊娠结局不良的风险,但是选择性妊娠组患者妊娠期间疾病稳定状况、母婴的预后均优于非选择性妊娠组.     

妊娠合并系统性红斑狼疮94例临床分析

目的 寻找妊娠合并系统性红斑狼疮(SLE)患者妊娠及产后不良母婴预后的因素.方法 回顾性分析北京协和医院妇产科收治的妊娠合并SLE患者的临床资料,根据SLE活动与否,将患者分为SLE不活动组和SLE活动组.用logistic回归分析影响不良母婴结局的危险因素.结果 妊娠合并SLE者97例,其中3例失访,94例SLE患者共96例次妊娠,96例次妊娠中SLE不活动组36例次,SLE活动组60例次.96例次妊娠中18例次为治疗性引产或人工流产,胎儿丢失7例次,活产71例次,3例新生儿死亡.SLE活动组早产、小于胎龄JD(SGA)、窒息发生率高于SLE不活动组(P＜0.05).logistic回归分析显示,胎儿不良结局与子痫前期/子痫、低血小板血症、SLE活动等因素有关(13值分别为2.463、2.228、2.769,P＜0.05).96例次妊娠中56例次孕前SLE稳定,其中22例次(39.3%)在妊娠期和产后发生SLE活动.共有24例子痫前期,2例子痫.合并狼疮肾炎(LN)者52例次,孕前LN控制稳定者有25例次(48.1%,25/52),其中稳定1年以上者22例次,妊娠期有12例次发生LN活动;而LN稳定短于1年者3例,妊娠期全部发生LN活动.4例产妇死亡,均发生于产后.logistic回归分析显示,子痫前期/子痫与LN活动呈正相关(β值2.658,P＜0.05),而SLE活动与孕前尿蛋白呈正相关(13值3.263,P＜0.05).结论 SLE患者妊娠后胎儿丢失、早产、SGA、新生儿窒息的发生率在SLE活动时显著增加.约1/3的SLE患者在妊娠后出现SLE活动,LN活动时子痫前期、子痫发生率显著升高.     

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.     

系统性红斑狼疮对妊娠结局影响的病例对照研究

目的认识系统性红斑狼疮(SLE)对妊娠不良影响的程度。方法运用病例对照研究方法分析24例SLE妇女44次妊娠及48名健康妇女94次妊娠的结局。结果SLE组末次妊娠平均年龄为(29±4)岁,健康组为(29±4)岁;两组平均妊娠次数分别为(1.9±0.8)次/人和(2.0±0.8)次/人(P=0.7);活产率分别为56.8%和72.3%(P=0.07);去除人工流产后胎儿丢失率分别为28.6%和13.9%(OR=2.47,95%CI:0.82￣7.27,P=0.07);早产和/(或)分娩低体重儿分别为32%和1.5%(OR=20.67,95%CI:2.56￣926.38,P<0.01)。合并狼疮肾炎和/(或)高血压病例的胎儿丢失相对危险度为4.6(95%CI:1.08￣18.56,P=0.021。1年内有病情活动或妊娠初次发病者的胎儿丢失率分别为60%和15%,早产和/(或)低体重儿率分别为80%和50%,较病情稳定1年以上的SLE妊娠高(分别为6%和13.3%)。结论SLE对妊娠结局有较大的不良影响,表现为SLE妇女胎儿丢失、早产和分娩低体重儿的风险均高于健康妇女。合并狼疮肾炎或高血压的SLE妊娠,这些风险将进一步升高。SLE病情控制1年以上妊娠,胎儿的安全性提高。     

系统性红斑狼疮不良妊娠结局相关因素

目的 探讨系统性红斑狼疮(systemic lupus erythematosus, SLE)患者不良妊娠结局的相关因素。方法 对83例SLE患者85次妊娠事件的临床资料进行回顾性分析,采用Logistic回归模型分析不良妊娠结局的相关因素。结果 病情活动的SLE患者发生妊娠丢失(60%)、早产(30%)、子痫前期(43%)的风险更高(P<0.05)。SLE患者胎儿不良妊娠(adverse pregnancy outcomes, APO)和妊娠丢失组出现孕中发病、病情活动、白细胞下降、低补体、抗dsDNA阳性及泼尼松用量≥20 mg/d的比例升高。且接受临床干预的具有不良妊娠史(OR=5.837,95%CI:1.799～18.911,P=0.003)的SLE患者再次妊娠时,出现胎儿AP0的风险降低,其中皮疹(OR=0.047,95%CI:0.005～0.453,P=0.008)、抗SSA阳性(OR=0.265,95%CI:0.084～0.838,P=0.024)、泼尼松用量≥20 mg/d(OR=0.062,95%CI:0.010～0.391,P=0.003)是SLE胎儿APO相...     

妊娠期高血压患者不良妊娠结局危险因素及干预对策研究

目的探讨影响妊娠期高血压患者不良妊娠结局的危险因素,并提出临床干预对策。方法对2010年4月至2015年5月我院收治的妊娠期高血压患者114例的临床资料进行回顾性分析。结果产妇不良妊娠结局的影响因素有疾病的严重程度(OR=2.136,P0.05)及蛋白尿(OR=4.379,P0.05);胎儿不良妊娠结局的影响因素有蛋白尿(OR=2.003,P0.05)及分娩孕周(OR=5.218,P0.05);新生儿不良妊娠结局的影响因素有疾病的严重程度(OR=2.961,P0.05)及分娩孕周(OR=6.278,P0.05);产妇-胎儿/新生儿不良妊娠结局的影响因素有蛋白尿(OR=3.024,P0.05)及分娩方式(OR=3.147,P0.05)。结论影响妊娠期高血压患者不良妊娠结局的因素较多,应加大对患者进行健康教育的力度,使患者积极主动进行产前检查,同时积极进行预防和治疗以降低不良妊娠结局发生的概率。     

血清标志物β-痕迹蛋白、转甲状腺素蛋白和非酯化脂肪酸与妊娠期高血压疾病严重程度的关系及联合诊断预测不良妊娠结局的价值

目的 探讨不同妊娠期高血压疾病严重程度患者血清标志物β-痕迹蛋白(BTP)、转甲状腺素蛋白(TTR)和非酯化脂肪酸(NEFA)水平,并分析其联合诊断对不良妊娠结局的预测价值。方法 以2020年1月至2021年12月在新乡市中心医院治疗妊娠期高血压疾病的患者152例为研究对象(病例组),其中妊娠期高血压55例,子痫前期59例,重度子痫前期38例;对照组为同期进行常规产检且血压正常的单胎妊娠期妇女150人。足月分娩且新生儿Apgar评分≥8分定义为妊娠结局良好。自发流产、胎盘早剥、HELLP综合征、产后出血、早产、胎儿宫内生长受限、新生儿窒息以及Apgar评分<8分定义为不良妊娠结局。比较病例组与对照组、不同病情程度患者、不同妊娠结局患者血清BTP、TTR、NEFA表达水平,采用受试者工作特征(ROC)曲线分析BTP、TTR、NEFA及联合诊断对不良妊娠结局的预测价值。结果 妊娠期高血压、子痫前期和重度子痫前期患者BTP高于对照组[(5.08±0.85)比(5.32±1.04)比(5.63±0.78)比(0.88±0.01)ng/L,F=1 491.52]、TTR[(423.55±3...     

地特胰岛素联合门冬胰岛素治疗妊娠合并糖尿病患者的安全性及有效性研究

目的分析对比地特胰岛素联合门冬胰岛素与精蛋白生物合成人胰岛素联合门冬胰岛素治疗妊娠合并糖尿病患者的安全性、有效性及分娩结局。方法选取2013年1月至2014年12月接受孕期检查并分娩的需用基础-餐前胰岛素治疗的妊娠合并糖尿病患者110例,其中,孕前糖尿病合并妊娠(PGDM)50例,GDM 60例,按1:1比例随机分为地特胰岛素组(Det,n=55)及精蛋白生物合成人胰岛素组(NPH,n=55)。Det组予地特胰岛素联合门冬胰岛素治疗;NPH组予精蛋白生物合成人胰岛素联合门冬胰岛素治疗。对比两组胰岛素治疗前后血糖变化、血糖达标时间、治疗期间低血糖发生率及分娩结局。结果治疗1周后,与NPH组比较,Det组平均2 hPG[(7.6±1.1)vs(6.9±0.9)mmol/L]降低(P=0.001);Det组血糖达标时间[FPG(7.1±3.2)vs(4.8±2.9)d;2 hPG(8.7±3.0)vs(5.7±3.6)d;FPG及2 hPG均达标(10.9±2.8)vs(6.8±4.1)d]均缩短(P=0.000)。Det组及NPH组治疗期间低血糖发生率分别为10.9%、25.5%,差异有统计学意义(P0.05)。两组分娩孕周、剖宫产率、妊娠期高血压、巨大儿,新生儿低血糖、新生儿高胆红素血症、新生儿体重及转NICU比较,差异均无统计学意义(P0.05)。结论对于妊娠合并糖尿病者,地特胰岛素联合门冬胰岛素能更快、更有效地控制血糖,明显减少注射次数和低血糖发生率,未增加不良分娩结局。     

心理护理联合运动疗法在妊娠糖尿病护理中的应用

目的探究对妊娠糖尿病患者实施心理护理联合运动疗法的效果。方法随机将2016年3月—2018年3月该院96例妊娠糖尿病患者分为观察组(48例,应用常规护理+心理护理+运动疗法)、对照组(48例,应用常规护理)。对比两组患者的血糖(空腹血糖及餐后2 h血糖)情况、焦虑评分、抑郁评分、妊娠结局及新生儿并发症发生率。结果观察组患者分娩前空腹血糖(4.85±0.76)mmol/L、餐后2 h血糖(9.23±0.89)mmol/L均低于对照组(5.96±0.82)mmol/L、(10.78±0.78)mmol/L(P0.05);观察组患者分娩前焦虑评分(42.85±2.76)分、抑郁评分(41.32±1.69)分均低于对照组(47.65±2.82)分、(46.78±2.78)分(P0.05);观察组不良妊娠结局发生率(6.25%)低于对照组(18.75%)(P0.05);观察组新生儿并发症发生率(4.17%)低于对照组(18.75%)(P0.05)。结论对妊娠糖尿病患者实施心理护理联合运动疗法具有较佳的效果,更有助于降低其血糖水平,改善患者不良心理状况及妊娠结局。     

多普勒超声对妊娠期高血压患者子宫动脉血流的检测情况分析

目的探讨多普勒超声对妊娠期高血压患者子宫动脉血流的检测情况。方法选择我院2015年2月至2016年2月我院接诊的80例妊娠期高血压患者作为观察组,并选择同期我院接诊的80例正常妊娠产妇作为对照组。使用美国GE Voluson E8超声多普勒血流检测仪,比较两组子宫动脉血流及妊娠结局;并根据是否出现舒张早期切迹将观察组分为切迹组和无切迹组,比较两组妊娠结局。结果观察组阻力指数、搏动指数、收缩-舒张流速比值均比对照组高[(0.59±0.06)vs(0.51±0.03),(0.95±0.18)vs(0.72±0.12),(2.47±0.52)vs(2.01±0.31)],差异均具有统计学意义(P0.05);观察组新生儿体重明显低于对照组,早产、剖宫产、胎儿窘迫明显高于对照组,差异均具有统计学意义(P0.05);在观察组中,舒张早期切迹发生率为45.00%(36/80),切迹组新生儿体重明显低于无切迹组,早产、羊水异常、胎儿窘迫发生率均明显高于无切迹组,差异均具有统计学意义(P0.05)。结论在妊娠期高血压患者中应用多普勒超声检测子宫动脉血流动力学有助于预测不良妊娠结局,临床应用价值高。     

Outcome of lupus pregnancy: a controlled study

OBJECTIVE: The reciprocal relationship between systemic lupus erythematosus (SLE) and pregnancy was investigated in a controlled study. METHOD: The outcome of 47 pregnant SLE patients with 59 pregnancies was compared with that of 57 healthy control women and 59 pregnancies. The results were also compared with those of 59 non-pregnant control SLE patients. RESULTS: All pregnant SLE patients but one were in remission at the onset of pregnancy and were being treated with low doses of prednisone (< or = 10 mg/day, 26 patients), hydroxychloroquine (200 mg/day, eight patients) or azathioprine (100 mg/day, one patient). Sixty-one per cent of SLE pregnancies were delivered at term and 5% had premature deliveries. The rates of spontaneous abortion and total fetal loss were significantly higher in the mothers with SLE than in the control population (P: < 0.001 and P: < 0.01 respectively). None of the 39 neonates from SLE mothers had neonatal lupus, anti-Ro(SSA) or anti-La(SSB) antibodies. Eight out of 59 pregnancies of SLE mothers (13.5%) were characterized by disease exacerbation. Arthralgias or arthritis, fever and skin lesions were observed more frequently in the mothers with SLE than in the non-pregnant group (P: < 0.001). Renal involvement was found in three SLE patients during pregnancy and in three after delivery. CONCLUSIONS: Pregnant women with SLE are at high risk of fetal loss and spontaneous abortion. Pregnancy does not cause life-threatening manifestations of the disease. Thus, for a better outcome of lupus pregnancy, it is essential to control disease activity and to achieve clinical remission.     

Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies

The aim of this study was to analyse pregestational and pregnancy risk factors for adverse fetal and maternal outcome in lupus pregnancy. Twenty women with systemic lupus erythematosus (SLE) (29 pregnancies) were prospectively evaluated. Mean patient age was 29.5+/-4.7 years, and mean disease duration, 6.3+/-6.5 years. Twenty-two pregnancies (75.9%) ended in live births; preterm delivery occurred in 17.4%, intrauterine growth restriction in 50%, preeclampsia in 3.7%, and gestational hypertension in 8%. Six pregnancies (20.7%) ended in spontaneous abortions. Adverse live-birth outcome was significantly associated with low pregestational serum albumin level, elevated gestational anti-dsDNA antibody, and diabetes mellitus. Spontaneous abortion was directly associated with low levels of pregestational serum albumin, positive anticardiolipin IgA, anti-beta2-glycoprotein I IgM, and anti-La antibodies, and inversely associated with number of patients' children. Postgestational lupus flare-up was noted in six pregnancies. Risk factors included high pregestational SLE Disease Activity Index (SLEDAI), lower serum albumin, elevated serum antibody to dsDNA, proteinuria, and use of prednisone and hydroxychloroquine. We conclude that despite high rate of obstetrical complications and postpartum lupus flare-up, pregnancy poses low risk for the majority of women with SLE.     

Preterm deliveries in women with systemic lupus erythematosus

OBJECTIVE: To compare the clinical, laboratory, and demographic variables of women in our clinic with systemic lupus erythematosus (SLE) who have had a pregnancy resulting in a live birth and identify any correlations with either term or preterm delivery. METHODS: Pregnancies in women with SLE from 1999 to 2001 were retrospectively reviewed. We recorded demographic data, disease activity (SLE Disease Activity Index, SLEDAI), obstetric history, prednisone dosage, other medications taken during pregnancy, history of renal disease, and autoantibody status [including antinuclear antibody, anti-DNA, anticardiolipin IgG (aCL), and lupus anticoagulant (LAC)]. Preterm delivery was defined as gestational age at delivery < 37 weeks. We performed a literature survey using PubMed and the key words SLE, pregnancy, and outcome. RESULTS: Of the 72 pregnancies, 28 (38.9%) resulted in preterm deliveries. There were no significant differences in any demographic or disease variables measured comparing term versus preterm delivery groups. More women in the preterm group were taking > or = 10 mg/day prednisone during their pregnancy (50.0% vs 22.2%; p = 0.028), and the mean dose was significantly higher than the term group taking > or = 10 mg/day (24.8 vs 16.7 mg/day; p = 0.047). There was a higher prevalence of women with aCL IgG in the preterm group (p = 0.023). The mean weeks gestation was shorter for women positive for aCL IgG compared to the group negative for aCL (34.9 +/- 4.4 vs 37.5 +/- 3.2 weeks, respectively; p = 0.032). There was no difference in second trimester disease activity between the term and preterm groups (33.3% and 36.4% of each group had a SLEDAI of 0). However, significantly more women in the term group received no medication during their pregnancies compared to women in the preterm group (20.0% vs 0.0%; p = 0.031). CONCLUSION: The rates of preterm deliveries, premature rupture of membranes, intrauterine growth restriction, and aPL in SLE pregnancies vary considerably in published reports, most of which are retrospective analyses. Our rates closely approximate the median values for all measures. We found preterm deliveries to be associated with disease activity (as determined by the use of any medication throughout pregnancy vs no medication, and prednisone dose > or = 10 mg/day) and the presence of aCL IgG but not LAC. Our results suggest that inactive disease rather than controlled disease at the onset of pregnancy may be the determining factor in extending SLE pregnancies to full term, thereby decreasing maternal and fetal morbidity.     

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.     

Clinical and serological risk factors of systemic lupus erythematosus outcomes during pregnancy

IntroductionSLE is an important risk factor for mother and fetus during pregnancy.Aim of the workTo identify clinical and serological risk factors that may cause poor maternal and fetal outcomes in pregnant systemic lupus erythematosus (SLE) patients.Patients and methodsForty selected SLE pregnant women (group A) versus 35 non-pregnant SLE patients (group B). SLE disease activity index (SLEDAI) and flares were evaluated for both groups. Laboratory investigations included double stranded DNA, anticardiolipin antibodies (aCL), and complements (C3 & C4). SLE pregnant patients were followed up in the second and third trimesters by ultrasonography and fetal Doppler were done to assess fetal outcome. Risk factors for poor maternal and fetal outcome were recorded.ResultsSLEDAI was increased in both groups more in group A. Lupus flares were increased during pregnancy as it occurred in (62.5%) of group A compared to (37.14%) in group B where severe flares were more frequent in group A. Gestational hypertension and active SLEDAI were found statistically significant for poor maternal outcome. Fetal outcome included full term 37.5%, prematurity 25%, intra-uterine growth retardation (IUGR) 22.5%, stillbirth 12.5%, abortion 7.5% and congenital heart block (CHB) 2.5%. Factors significantly associated with poor fetal outcome were severe flares and active renal disease where fetal loss significantly associated with aCL antibodies. Full term was more common in patients with no flares.ConclusionThese data demonstrate that pregnancy in SLE patients should be considered as a high-risk pregnancy and conception should be planned during a quiescent period. Close monitoring for optimal disease control of flares, lupus nephritis, gestational hypertension and aCL antibodies is recommended.     

系统性红斑狼疮合并中枢神经系统感染与神经精神性狼疮的临床区别

目的 了解系统性红斑狼疮(SLE)患者发生中概神经系统(CNS)感染与神经精神性狼疮(NPSLE)的临床区别.方法 回顾分析既往4年收治的12例合并CNS感染的SLE住院患者临床表现、实验室检查和预后情况.和同期收治的15例中枢性NPSLE住院患者进行对比分析,采用两样本均数的t检验,Mannwhitney检验和Fisher确切概率法进行统计学处理.结果 12例合并CNS感染的SLE患者中女性10例占83%,平均发病年龄(37±4)岁.与NPSLE患者ISLE疾病活动指数(SLEDAI)(14.3±1.6)]相比,合并CNS感染的SLE患者SLEDA1(6.4±1.2),狼疮活动性低(P<0.01),而发病前糖皮质激素用量大[(28:3±2.5)mg/d与(8.4±3.0)mg/d](P<0.01),应用免疫制剂者多(83%与33%,P<0.05.合并CNS感染的SLE患者临床症状以头痛、发热最为常见(P<0.01),其血清白蛋白水平[(34.2±1.2)g/L]高于对照组[(29.9±1.6)g/L](P<0.05);脑脊液检查显示,这些患者白细胞数显著升高[(326±104)/μl与(5±3)/μl,P<0.01],糖含量显著降低[(1.38±0.27)mmol/L与(3.47±0.29)mmol]L,P<0.01],蛋白水平[(1246±155)mg/L]亦较对照组[与(669±206)mg/L]增高(P<0.05).结论 SLE患者发生CNS感染后预后不佳.长期使用大剂量激素和免疫抑制剂者如出现不能解释的头痛、发热症状且狼疮整体活动性不高时,应及时行脑脊液检查排除此病.     

系统性红斑狼疮患者外周血干扰素α、白介素6和肿瘤坏死因子α水平

摘要： 目的 检测系统性红斑狼疮（SLE）患者血清中干扰素α（interferon α,IFN-α）、白介素6（interleukin 6,IL-6）和肿瘤坏死因子α（tumor necrosis factor α,TNF-α）的水平,探讨其在SLE中的作用.方法 采用酶联免疫吸附法检测SLE患者及正常对照者血清IFN-α、IL-6及TNF-α水平;分析其与SLE实验室指标及临床表现的相关性.结果 SLE患者外周血中IFN-α、IL-6水平显著高于正常对照组,差异均有统计学意义[（4.99±7.47）ng/L vs.（2.07±1.98）ng/L,（4.36±7.62）ng/L vs.（1.72±2.87）ng/L,均P〈0.05];其中活动期SLE患者IFN-α水平明显高于稳定期,差异有统计学意义[（9.79±12.04）ng/L vs.（3.13±3.47）ng/L,P〈0.05].SLE患者血红蛋白减低组血清IFN-α水平显著高于血红蛋白正常组,差异有统计学意义[（5.34±6.36）ng/L vs.（2.84±3.58）ng/L,P〈0.05];抗双链DNA抗体阳性患者血清IFN-α、IL-6水平明显高于阴性者,差异均有统计学意义[（7.35±8.12）ng/L vs.（4.22±8.11）ng/L,（10.26±12.76）ng/L vs.（2.37±1.61）ng/L,均P〈0.05].SLE患者血清IFN-α水平与TNF-α、SLE疾病活动指数积分、抗双链DNA抗体呈正相关（r=0.303,P〈0.05;r=0.427,P〈0.01;r=0.368,P〈0.05）,与血红蛋白水平呈负相关（r=-0.345,P〈0.05）;IL-6水平与血细胞沉降率、抗双链DNA抗体呈正相关（r=0.526,P〈0.01;r=0.437,P〈0.05）.SLE患者血清IFN-α水平在有血液系统受累患者中表达水平明显升高,差异有统计学意义（P〈0.05）;血清IL-6水平在伴有发热、关节炎或血液系统损害的患者中明显高于无上述临床表现的患者,差异具有统计学意义（P〈0.01或P〈0.05）.结论 SLE患者外周血细胞因子分泌存在异常,各细胞因子相互作用,共同参与疾病的发生与发展.     

以干燥综合征起病的系统性红斑狼疮临床及预后分析

目的 探讨以干燥综合征(SS)起病的系统性红斑狼疮(SLE)患者(SSISLE)的临床特点及预后. 方法 1998年2月至2008年2月在北京协和医院SS/SLE住院患者共41例,同时期非SS起病的SLE患者(NSS/SLE)共2331例,随机抽取其中214例患者作为对照组,比较分析两者的临床、实验室特点、治疗和预后.结果 SS/SLE和NSS/SLE患者间在以下几方面差异有统计学意义(P均＜0.05):①性别(女,男)(41/0与184/30)、SLE发病年龄[(43±41)岁与(32±31)岁]、病程[(114±84)个月与(45±18)个月];②临床表现:口干(85.3%与6.1%)、眼干(75.6%与2.3%)、面部红斑(9.8%与46.3%)、肾小管酸中毒(21.9%与0)、肾病综合征(7.3%与31.3%)、中枢神经系统症状(4.9%与19.6%)、肺间质病变(12.2%与2.8%);③实验室检查:红细胞沉降率(ESR)[(65±75)mm/1 h与(46±34)mm/1 h]、IgG升高(56.4%与29.9%)、IgA升高(38.5%与20.4%)、类风湿因子(RF)阳性(70.8%与20.3%),抗SSA抗体阳性(82.9%与43.4%)、抗SSB抗体阳性(39.0%与7.9%);④SLE疾病活动指数(SLEDAI)评分(8±8与10±10)、激素治疗强度(冲击/相当于1～2 mg·kg-1·d-1泼尼松,＜1 mg·kg-1·d-1泼尼松)(8/26/7与91/102/21)、死亡和(或)永久脏器损害(2.4%与14.9%).对SS/SLE患者平均随访(33±34)个月,除1例因合并抗磷脂综合征出现肺栓塞死亡外其余患者均病情稳定. 结论 SS/SLE发病年龄晚,病情较轻,面部红斑、中枢神经系统表现及肾病综合征相对少见,而肾小管酸中毒、肺间质病变相对多见,抗SSA、SSB抗体阳性率较高,预后较好.     

Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus

Disease activity 6 months before pregnancy of patients with systemic lupus erythematosus (SLE) associated with adverse maternal and fetal outcomes is not well studied. The aim of the study was to identify predictors of adverse maternal and fetal outcomes in pregnant SLE patients, based on patients' background characteristics, clinical and laboratory data 6 months before pregnancy. Of 103 pregnancies, 55 pregnancies in 39 SLE patients were investigated. Clinical and laboratory data were recorded at regular intervals from 6 months before conception to 1 year after delivery. Primary outcomes included the predictors of combined adverse maternal and fetal outcomes. Potential explanatory variables included demographic, clinical and laboratory data 6 months before conception. Using logistic regression, history of nephritis (p?=?0.001, odds ratio [OR] 13.3, 95% confidence interval [CI] 2.7-65.1) and a high SLE Disease Activity Index (SLEDAI) score 6 months before pregnancy (p?=?0.015, OR 1.7, 95% CI 1.1-2.7) were associated with combined adverse maternal outcome, whereas flare during pregnancy (p?=?0.003, OR 29.3, 95% CI 3.1-273.1) predicted combined adverse fetal outcome. The area under the curve for SLEDAI score of combined maternal outcome was 0.73 (95% CI 0.58-0.87). The optimal cut-off point according to the receiver operating characteristic curve was 4, with a sensitivity of 64% and a specificity of 75%. In conclusion, a history of nephritis or a SLEDAI score of 4 or more in SLE patients 6 months before conception predicts adverse maternal outcomes, while disease flare during pregnancy predicts adverse fetal outcomes. Pregnancies should be delayed until the disease has been in remission for 6 months.