64例次系统性红斑狼疮患者妊娠结局及临床分析

目的了解系统性红斑狼疮(systemic lupus erythematosus,SLE)患者妊娠结局,分析妊娠期间SLE病情恶化、不良妊娠结局的相关因素。方法回顾性分析64例次SLE患者妊娠的孕产史、临床及实验室资料。结果 60例SLE患者妊娠64例次,妊娠时年龄21~39岁,平均(28.4±4.1)岁,SLE病程2~12年,平均(5.5±3.1)年。共有26例次(40.6%)妊娠期间SLE病情恶化,恶化主要在妊娠中、晚期。妊娠足月产15例次(23.4%),早产23例次(35.9%)。治疗性流产21例次(32.8%),自然流产3例次(4.7%),死产2例次(3.1%)。总活产率59.4%。引起妊娠期间SLE病情恶化的危险因素有24 h尿蛋白定量(OR=15.76,95%CI:2.07~120.31)、妊娠前泼尼松剂量(OR=1.18,95%CI:1.01~1.38)。引起胎儿丢失的危险因素有补体C3水平(OR=0.002,95%CI:0.000~0.410)、妊娠前疾病活动(OR=8.297,95%CI:1.464~47.029)。结论应制定合理有效的治疗方案积极控制妊娠前病情,并在妊娠期间严密随访,以减少...

Clinical analysis of outcome of 64 pregnancies in patients with systemic lupus erythematosus

Objective To summarize the pregnancy outcome in patients with systemic lupus erythematosus （SLE） and to analyse the related factor of SLE exacerbations and poor outcome. Methods Retrospective analysis of maternal history, clinical and laboratory data of 64 pregnancies in patients with SLE was conducted. Results Sixty cases of SLE patients had 64 pregnancies in total, their gestational age range was from 21 to 39（28.4 ＋ 4.1 ） years old and the duration of SLE was （5.5 ± 3.1） years （2 to 12 years）. SLE exacerbation occurred in 26 pregnancies （40.6%）, mostly in the second and third trimester of pregnancy. There were 15 cases of mature delivery （23.4%）, 23 cases were premature （35.9%）, 21 cases of therapeutic abortion （32.8%）, 3 cases of spontaneous abortion （4.7%） and 2 cases of stillbirth （3.1% ）. The total live birth rate was 59.4%. The predictor of SLE exacerbation during pregnancy were 24 h urinary protein before pregnancy （ OR = 15.76, 95% CI ： 2.07～ 120.31 ） and prednisone dose （ OR = 1.18,95% CI ： 1.01 ～ 1.38）. The predictors of fetal loss included C3 levels （ OR = 0. 002,95 % C1：0. 000～ 0. 410）and SLE disease activity be- fore pregnancy （ OR = 8. 297,95% （71 ： 1. 464～47. 029）. Conclusions Rational and effective treatment should be devel- oped to actively control the disease before pregnancy and close follow-up during pregnancy, to reduce risk factors for ad verse pregnancy outcomes and improve pregnancy outcomes.