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.

Predictors of maternal and fetal outcome in systemic lupus erythematosus: a retrospective study of 94 cases

Objective To evaluate the predictors of maternal and fetal outcome of pregnancy for systemic lupus erythematosus(SLE)patients.MethodsNinety-four patients with 96 pregnancies which were evaluated retrospectively from Jan 1990 to Jan 2008 in Peking Union Medicai College Hospital were divided into two groups:disease stable during pregnancy(group A)and lupus flares during pregnancy (group B).Statistical analysis was performed by X2 or Fisher exact test and Student's t-test.A binary logistic regression model was used to evaluate the predictors of matemal and fetal outcome.Results There were 36 pregnancies with stable lupus disease(group A)and 60 pregnancies with lupus flares(group B).of the 96 pregnancies.18 resulted in therapeutic abortion and 7 in fetal loss,71 resulted in a live birth,3 in neonatal death.The rates of preterm delivery,small gestational age(SGA)and neonatal asphyxia in group B were higher than those in group A(P＜0.05).By binary logistic regression analysis,preeclampsia/eclampsia low serum platelet count and SLE flares were associated with poor fetal outcome(β=2.463,2.228.2.769 respectively.P＜0.05).,rhere were 56 pregnancies with stable lupus disease at the conception with 22(39.3%)occurred lupus flares during pregnancies.Twenty-four preeclampsia and 2 eclampsia were seen in all the pregnancies.Fifty-two pregnancies were complicated with lupus nephritis,and 25 pregnancies(48.1%,25/52)of which were disease stable at the conception,and among 22 pregnancies with disease stable over one year.twelve of which occurred lupus nephritis flares.Three pregnancies which have disease activity within one year before pregnancy all occurred lupus nephritis flares.There were four maternal death which all occurred at the postpartum.By binary logistic regression analysis,lupus nephritis flares were associated with preeclampsia/eclampsia(B=2.658,P＜0.05),and proteinuria at the conception before dilivery were significantly associated with SLE flares(13=3.263,P＜0.05).Conclusion An increase of fetal loss,preterm delivery,SGA and neonatal asphyxia was seen in patients with lupus flares during pregnancy compared with those with stable disease.About 1/3 lupus activity may increase after pregnancy.Preeclampsia and eclampsia were increased when there were lupus nephritis flares.