子宫动脉频谱形态异常可预测系统性红斑狼疮患者的妊娠结局

目的探讨子宫动脉多普勒在预测系统性红斑狼疮（SLE)合并妊娠母胎结局中的应用价值。方法回顾性选取45例系统性红斑狼疮合并妊娠孕妇，分析两组患者的临床情况及新生儿结局，并根据子宫动脉多普勒频谱是否出现切迹、搏动指数（PI)值增高，将患者分为正常组（n=31)及异常组（n=14)，比较两组间的差异。结果45例孕妇中，15例（33%)出现子痫前期、狼疮性肾炎及抗磷脂综合征，胎儿出现不良结局共9例（20%)。子宫动脉频谱正常组31例（69%)，5例（11%)孕妇发生子痫前期，1例（2%)胎儿发生小于胎龄儿。子宫动脉频谱异常组14例（31%)，10例（22%)孕妇出现并发症，包括子痫前期、狼疮性肾炎，抗磷脂抗体（+)及抗磷脂综合征；8例（18%)胎儿发生不良结局:包括小于胎龄儿、胎儿生长受限及胎儿丢失。3例（7%)妊娠期新发SLE患者，孕妇子宫动脉波形均出现异常（波形出现切迹、PI值增高)，3例胎儿均于围生期死亡。子宫动脉波形异常组母体并发症及胎儿不良结局的发生率均高于波形正常组，组间差异有统计学意义（P < 0.01)。结论孕妇子宫动脉频谱形态异常是预测妊娠期SLE加重及胎儿发生不良结局的敏感指标。 

Uterine artery Doppler abnormal findings in prediction of adverse pregnancy outcome in systemic lupus erythematosus

ObjectiveTo explore the predictive value of the uterine artery Doppler in systemic lupus erythematosus (SLE) pregnancies.MethodsData of 45 pregnancies in SLE patients from January 2010 to December 2020 were analysed retrospectively. Pregnancy and neonatal outcomes were collected. Adverse pregnancy outcome was defined as one of the following: pre-eclampsia, lupus nephritis, APS, APA(+), pre-term birth, small for gestational age, fetal growth restriction and placental abruption. Pulsatility index (PI) of the uterine artery were monitored by Doppler ultrasound. An increased pulsatility index and an early diastolic notch of uterine artery is consider with abnormal.ResultsAmong the 45 pregnant women, 15 (33%) developed preeclampsia, lupus nephritis, and antiphospholipid syndrome (APS), and 9(20%) fetuses had adverse outcomes. Complications include preeclampsia, lupus nephritis, antiphospholipid antibody (+) and antiphospholipid syndrome. In the 31 (69%) normal cases uterine artery spectrum group, 5 cases (11%) of pregnant women developed preeclampsia, and 1 case (2%) of fetus developed small for gestational age.14 women (31%) in the spectrum abnormality group and complications occurred in 10 women (22%). 8 cases (18%) had adverse fetal outcomes, including small for gestational age, fetal growth restriction and fetal loss. 3 patients (7%) with new SLE during pregnancy showed abnormal uterine artery waveforms (waveforms showed incisions and increased PI), and all three fetals died in perinatal period.ConclusionAn increased pulsatility index and an early diastolic notch in the waveform has been associated with an increased risk for adverse pregnancy outcomes.