[1]宋秀珍,陈嘉棉,周秋根.66例系统性红斑狼疮患者的妊娠转归[J].南方医科大学学报,2016,(12):1732.
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66例系统性红斑狼疮患者的妊娠转归()
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《南方医科大学学报》[ISSN:/CN:]

卷:
期数:
2016年12期
页码:
1732
栏目:
出版日期:
2016-12-20

文章信息/Info

Title:
Analysis of pregnancy outcomes in 66 patients with systemic lupus erythematosus
作者:
宋秀珍陈嘉棉周秋根
关键词:
系统性红斑狼疮妊娠不良妊娠结局
Keywords:
systemic lupus erythematosus pregnancy adverse pregnancy outcomes
摘要:
目的研究系统性红斑狼疮(SLE)患者妊娠后母婴结局及其相关的危险因素。方法回顾性分析(2006年10月~2015年9 月)南方医院SLE妊娠住院患者的临床资料,比较疾病缓解-轻度活动组(SLEDAI≤9分)和中-重度活动组(SLEDAI>9分)妊娠 结局、母婴并发症,分析不良妊娠结局的危险因素。结果66位SLE 患者共妊娠69次,确诊SLE时平均年龄22.9±5.1岁;妊娠时 SLE平均病程4.1±3.6 年;妊娠期间45 例(65.2%)接受药物治疗,44 例(63.8%)应用糖皮质激素,其中27 例(39.1%)剂量小于 20 mg/d,17例(24.6%)剂量高于20 mg/d,19例(27.5%)应用羟氯喹,孕期SLEDAI最高评分平均为6.8±7.4分。同病情缓解-轻 度活动组相比,中-重度活动组胎儿丢失率[12(54.5%)vs 12(25.5%)]高于前者,新生儿出生体质量[(2073.0±778.7)g vs (2817.8±533.7)g]低于前者(P<0.05);中-重度活动组SLE新发[9(40.9%)vs 6(12.8%)]、高血压[12(54.5%)vs 3(6.4%)]、活动 性狼疮肾炎[22(100%)vs 4(8.5%)]、肺部感染[5(22.7%)vs 2(4.3%)]、肾功能不全[8(36.4%)vs 2(4.3%)]多于病情缓解-轻度活 动组,差异有统计学意义(P<0.05);活动性狼疮肾炎(OR=6.10,95% CI:1.43-25.96)是不良妊娠结局的独立危险因素。结论 SLE患者孕期狼疮中-重度活动增加胎儿丢失、母亲并发症的发生,活动性狼疮肾炎是不良妊娠结局的独立危险因素。狼疮患 者妊娠转归仍有待进一步提高,妊娠期间应定期监测SLE患者各项指标,合理用药,控制狼疮活动,以获得良好的妊娠结局。
Abstract:
Objective To analyze the outcomes of pregnancies in women with systemic lupus erythematosus (SLE) and the risk factors affecting the outcomes. Methods The data of SLE patients with pregnancy admitted from October, 2006 and September, 2015 were analyzed for assessing the maternal and fetal outcomes and complications. Their risk factors affecting the outcomes of the pregnancies were analyzed. Results The 66 SLE patients (69 pregnancies) had a mean age at SLE diagnosis of 22.9 ± 5.1 years with a mean duration of SLE of 4.1±3.6 years before pregnancy. Forty-five (65.2%) of the patients received oral medication for SLE treatment during pregnancy, and 44 (63.8% ) were treated with prednisone and 19 (27.5% ) were treated with hydroxychloroquine. The highest SLEDAI score was 6.8±7.4 during pregnancy. The patients with moderate-to-severe disease activity had a higher rate of fetal loss (12[54.5%]vs 12[25.5%]) with a significantly lower birth weight of the newborns than those with remittent or mild disease (2073.0± 778.7 vs 2817.8±533.7 g, P<0.05). The patients with moderate-to-severe disease activity also had higher rates of new-onset SLE (9[40.9%]vs 6[12.8%]), hypertension (12[54.5%]vs 3[6.4%]), active lupus nephritis (22[100%]vs 4[8.5%]), pneumonia (5[22.7%]vs 2[4.3%]), and renal insufficiency (8[36.4%]vs 2[4.3%]) compared with patients with remittent and mild disease (P<0.05). Active lupus nephritis (OR=6.10,95%CI: 1.43-25.96) was a significant predictor of adverse outcomes of the pregnancies. Conclusion Fetal loss and maternal complications are common in patients with SLE in relation with the disease activity. Active lupus nephritis is a predictor for poor outcomes of pregnancies in SLE patients.

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更新日期/Last Update: 1900-01-01