妊娠合并系统性红斑狼疮66例临床分析

目的 探讨系统性红斑狼疮（SLE）患者妊娠时机及其对妊娠结局的影响。方法 回顾性分析2009年1月至2013年2月中山大学附属第一医院收治的66例妊娠合并系统性红斑狼疮患者的临床资料，依据妊娠时机，分为选择性妊娠组40例及非选择性妊娠组26例。结果 选择性妊娠组活产39例（97.5%），早产12例（30.8%），8例发生子痫前期（20.5%），妊娠期疾病出现活动10例(25％)；非选择性妊娠组活产6例(23.1％)，100%早产，4例发生子痫前期（66.7%），妊娠期疾病出现活动23例(88.5％)。选择性妊娠组妊娠期间疾病活动少于非选择性妊娠组(P<0.01)，活产率高于非选择性妊娠组(P<0.01)，早产率低于非选择性妊娠组(P=0.002)，子痫前期发生率低于非选择性妊娠组（P=0.035）。结论 SLE患者选择适当的妊娠时机，妊娠期间加强风湿免疫科及产科的监护，可以提高活产率；降低妊娠期间病情活动，可获良好的妊娠结局。

Clinical analysis of 66 cases of pregnant patients with systemic lupus erythematosus.

Abstract： Objective To investigate the pregnancy opportunity and outcome of patients with systemic lupus erythematosus(SLE)．Methods We carried out a retrospective analysis of the clinical information of 66 patients who suffered from SLE complicated with pregnancy and were hospitalized in our hospital from January of 2009 to February of 2013.Results In 40 cases of planned pregnancies, 39 cases(97.5%)resulted in live births and 10 cases(25%)had flares during pregnancy．Of the 39 live births, 12 cases(30.8%)were premature deliveries,and 8 cases(20.5%) had preeclampsia. In 26 cases of unplanned pregnancies, 6 cases(23.1%)resulted in live births and 23 cases(88.5%)had flares during pregnancy. The 6 cases(100%) of live births were all premature deliveries and 4 cases (66.7%) had preeclampia. The patients in the planned pregnancy group tended to have less flares during pregnancy than those in the unplanned group(P<0.01),and the former were more likely to have live births than the latter(P<0.01)，less likely to have premature delivery(P=0.002) and less likely to have preeclampsia (P=0.035). Conclusion Patients with SLE should have planned pregnancy and need collaborative supervision of both rheumatology and immunology department and obstetric department in order to improve live birth rate，decrease premature delivery and the activity of SLE during pregnancy,and can expect to have better pregnancy outcome.