系统性红斑狼疮肾炎患者妊娠的前瞻性观察(附47例报告)

目的了解系统性红斑狼疮(SLE)肾炎患者妊娠的母婴风险。方法前瞻性观察我院1998—2006年47例SLE肾炎患者的妊娠结果,依据妊娠前SLE病情,将患者分为SLE缓解期妊娠(A组,37例)、非SLE缓解期妊娠(B组,6例)和妊娠期初发SLE(C组,4例),分别观察妊娠期及产后半年内母亲的SLE病情和胎儿结局。结果共45例患者分娩活婴(1例分娩双胎),2例患者因疾病活动而中止妊娠。无自然流产和死胎,无母婴死亡。A组中,妊娠期SLE肾炎活动7例,肾功能损害1例;中止妊娠1例,早产10例,足月产26例。B组中,妊娠期SLE肾炎活动5例,肾功能损害1例;中止妊娠1例,早产4例,足月产1例。C组中,妊娠期内无肾功能损害,早产2例,足月产2例。B组患者妊娠期SLE肾炎活动构成比显著低于A组(P<0.01)。结论SLE肾炎患者妊娠的关键在于妊娠时机的选择,疾病缓解期妊娠可有效降低母婴风险。

Prospective study of pregnancy in 47 patients with lupus nephritis

Objective To evaluate the maternal-fetal risks during pregnancy in patients with lupus ne- phritis.Methods A prospective observation was done on the outcomes of pregnancies in 47 patients with lupus nephritis between 1998-2006 in Renji Hospital.The patients were divided into 3 groups:controlled lupus (Group A,n=37),uncontrolled lupus(Group B,n=6)and lupus onset during pregnancy(Group C,n=4). The intra-partum and post-partum lupus disease activity and the fetal outcomes were observed in all group within half year after delivery.Results Totally 45 patients had live deliveries,including 1 with twin.Two patients re- ceived therapeutical abortion due to severe disease flare.There was no natural abortion and stillbirth,nor mater- nal-fetal deaths.Seven patients in Group A had intra-partum lupus nephritis flare(19%);one had therapeutical abortion and 1 had transient renal damage;and 10 had preterm deliveries and 26 cases of full term deliveries. Five patients in Group B had intra-partum lupus nephritis flare(83%);1 had therapeutical abortion and 1 had permanent renal damage;and 4 had preterm deliveries and 1 had full term delivery.No renal deterioration was found in Group C;2 patients had pre-term delivery and 2 had therapeutical abortion.There was significant difference in intra-partum lupus nephritis flare between Group A and Group B(P<0.01).Conclusion The key for a safe out- come of pregnancy in lupus nephritis patients is proper timing of conception.The control of lupus activity before pregnancy can effectively downregulate maternal-fetal risks.