妊娠合并系统性红斑狼疮22例次临床分析

目的探讨妊娠合并系统性红斑狼疮(SLE)患者妊娠期病情恶化及影响妊娠结局的因素。方法对妊娠合并SLE患者18例,共妊娠22例次的临床资料进行回顾性分析。结果22例次妊娠中,妊娠前SLE病情处于缓解期15例次,妊娠和产后SLE活动4例次(26.7%);妊娠前处于SLE活动期7例次,妊娠及产后病情恶化5例次(71.4%)。2组恶化率比较差异有统计学意义(P<0.05)。22例次妊娠中17例次出现产科并发症,包括妊娠高血压7例次,妊娠期糖尿病4例次,羊水过少3例次,子痫前期3例次。SLE活动期患者妊娠并发症发生率(12例次)明显高于SLE缓解期患者(5例次)。22例次妊娠中仅11例次(50.0%)为足月产,6例次(27.8%)早产,5例次(22.8%)因SLE病情活动被迫流产和引产。17例活产婴儿中有1例出生后3d死亡,低体质量儿7例占42.2%。13例新生儿做了抗体测定,5例ANA阳性,2例抗dsDNA抗体阳性,4例抗SSA抗体阳性,1例抗SSB抗体阳性,但无1例出现类狼疮综合征及新生儿狼疮,6个月后复查均转为阴性。结论妊娠前SLE病情活动是妊娠期SLE病情恶化和不良妊娠结局的主要因素。

Clinical analysis of 22 cases of pregnancy combined with systemic lupus erythematosus

Objective To investigate the exacerbation of pregnancy combined by systemic lupus erythematosus （SLE） and factors that may influence pregnant outcomes.Methods Retrospectively analyzed the clinic data of 18 patients with pregnancy combined with SLE,and 22 times of pregnancy in all.Results There were 15 times of pregnancy that SLE was in stable stage before patients in pregnant,4（26.7%） have seen SLE activities during and after pregnancy.In 7 times which SLE was in active stage before pregnancy,5（71.4%） have exacerbated after pregnancy. There existed statistical difference of exacerbation rate between the two groups（P0.05）.In 22 times of pregnancy,17 with obstetrical complications,including 7 cases of gestational hypertension,4 cases of gestational diabetes, 3 cases of hypamnion,and 3 cases of preeclampsia.Complication incidence in cases of active SLE（12 cases） was significantly higher than that in cases which SLE was in stable stage before pregnancy（5 cases）.In 22 times of pregnancy, 11（50.0%） were partus matures,6（27.8%） were premature delivery,and 5（22.8%） were aborted and induced labor due to SLE activities.In 17 cases of live births,1 died 3 days after birth,and 7（42.2%） with low birth weight.13 newborn infants were assayed antibody,5 were ANA positive,2 cases were anti-dsDNA positive,4 were anti -SSA positive,1 was anti-SSB positive,but none with SLE syndrome or neonatal lupus.All of the results turned into negative after re-assayed in 6 months.Conclusion Pre-pregnancies SLE active is the main factor cause SLE exacer-bation during pregnancy and infaust pregnancy outcome.