51例系统性红斑狼疮患者妊娠结局

目的研究系统性红斑狼疮(systemic lupus erythematosus,SLE)患者妊娠不良结局的发生率及引起不良结局的相关因素。方法回顾性分析51例在本院风湿免疫科规律随访并最终在本院产科分娩的SLE患者的病历资料,总结患者的妊娠结局、新生儿情况以及妊娠期间服用药物、分娩前SLE疾病活动度评分(systemic lupus erythomatosus disease activity index,SLEDAI)。比较不同疾病活动度组患者在药物治疗、不良妊娠结局发生率方面的不同,并比较不良妊娠结局组(妊娠胎儿丢失、新生儿死亡)与活产组患者药物治疗及疾病活动情况。结果 51例SLE患者的平均年龄(28.0±3.9)岁,平均病程(4.7±4.5)年,妊娠期间26例(51.0%)应用羟氯喹治疗,31例(60.8%)应用糖皮质激素治疗,平均剂量为泼尼松5 mgd(0~30 mgd)。分娩(或引产)前51例患者的SLEDAI为(11.8±10.3)分,其中SLE中-重度活动组患者20例(39.2%),8例(15.7%)引产;病情缓解-轻度活动组患者31例,无1例引产。共出生新生儿45例(其中2对双胎),新生儿死亡2例(4.4%);活产43例新生儿中2例(4.7%)发生新生儿狼疮。与疾病缓解-轻度活动组患者相比,中-重度活动组患者的平均住院时间(25.5±14.0)vs.(13.5±8.5)]、胎儿丢失率10(50.0%)vs.0(0.0)]及早产率9(63.6%)vs.9(21.4%)]均显著高于前者,差异有统计学意义(均P0.05);而应用糖皮质激素比例8(40.0%)vs.23(60.7%)]及用药剂量0(0,30)mg vs.6(0,20)mg]更低,但差异无统计学意义(P0.05)。不良妊娠结局(胎儿丢失及新生儿死亡)组分娩(或引产)前SLEDAI明显高于活产组(21.3±8.9)vs.(7.1±7.9),P0.01],而妊娠期糖皮质激素应用比例少于活产组(30.0%vs.68.3%,P=0.032),但两组在羟氯喹应用剂量上无明显差别0(0,20)mg vs.6(0,30)mg,P=0.096]。结论分娩前SLE活动度与妊娠不良结局(如胎儿丢失、早产及新生儿死亡)有关,疾病活动度高是发生妊娠不良结局的危险因素。

Outcome of 51 Pregnancies in Systemic Lupus Erythematosus

To study the risk of adverse pregnancy outcome in systemic lupus erythematosus （SLE） and related predictive factors.Methods Data of 51 pregnancies of systemic lupus erythematosus （SLE） patients from Department of Rheumatology in Peking University First Hospital were analyzed retrospectively. Pregnancy outcome,fetal features,treatment and SLEDAI before delivery were reviewed.Treatments and rate of adverse pregnancy outcomes were compared according to different SLE activity before delivery. Maternal treatments and disease activity were also assessed based on whether fetal loss happened or not. Results The age of patients was （28.0 ±3.9）years and the disease duration was （4.7 ±4.5）years. Twenty-six （51 .0%） patients were treated with hydroxychloroquine and 31 （60.8%） patients took prednisone during pregnancy.The mean dosage of prednisone was 5 mg （0-30 mg）daily.The mean SLEDAI was （1 1 .8 ±1 0.3）before delivery or abortion.In patients with severe active disease,8 of 20 patients （1 5.7%）suffered from abortion,while fetal loss happened in mild/moderate active disease group. There were 2 neonatal deats in 45 births （4.4%）and 2 neonatal lupus in 43 live births （4.7%）.The length of stay （25.5 ±1 4.0）vs.（1 3.5 ±8.5 ）],fetal loss 1 0 （50.0%）vs.0 （0.0）]and preterm delivery 9（63.6%）vs.9（21 .4%）]were higher in patients with severe active disease when compared to patients with mild/moderate disease （P 〈0.05 ）.While patients with severe active disease had lower proportion of steroid usage 8（40.0%）vs.23（60.7%）]and lower dosage 0（0,30）mg vs.6（0,20）mg] of prednisone compared to patients with mild/moderate disease.Compared to live births group,the SLEDAI before delivery or abortion was higher in the fetal loss group （21 .3 ±8.9）vs.（7.1 ±7.9）,P 〈0.01 ], while prednisone dosage during pregnancy was lower （30.0% vs.68.3%,P =0.032）.However,there was no difference in the usage of hydroxychloroquine 0 （0,20）mg vs.6 ?