狼疮肾炎患者妊娠的母婴不良结局的相关因素分析  

Related factors of adverse pregnancy outcomes in women with lupus nephritis

作　　者：叶蔚[1] 颜露春[1] 李玉婷[1] 张颖[1] 

机构地区：[1]广东医学院附属医院妇产科,湛江524000

出　　处：《生殖医学杂志》2015年第8期634-638,共5页Journal of Reproductive Medicine

摘　　要：目的分析妊娠妇女中狼疮。肾炎（LN）导致的母婴不良结局及其相关危险因素。方法选取我院2000年12月10日至2013年12月31日13年中收治的111例LN患者共117例次妊娠进行回顾性分析。按照LN的病情分为妊娠前疾病稳定组（n=78）、活动组（n=39）两组。分析妇女妊娠期病情加重、妊娠期或产后尿中蛋白含量增加和肾功能损害加重、子痫前期、低血小板血症、低补体血症等孕产妇不良结局情况，以及治疗需求的终止妊娠、胎儿丢失、早产、低出生体重儿、新生儿窒息、新生儿死亡及胎儿或新生儿的不良结局等情况。结果妊娠前LN稳定组与活动组比较，两组孕产妇的不良结局无显著性差异（P〉0．05）。活动组胎儿丢失或新生儿不良结局发生率高于稳定组（χ2=20．22，P〈0．001），其中早产发生率高于稳定组（χ2=5．14，P=0．023），因治疗需求终止妊娠率高于稳定组（χ2=16．71，P〈0．001），死胎／新生儿死亡率高于稳定组（χ2=9．54，P=0．002）；经Logistic回归分析，结果显示LN孕产妇病情加重的相关因素为低血小板血症（OR=0．303，95％CI0．125～0．736）和低补体血症（OR=0．056，95％CI0．006～0．507），发生子痫前期的相关因素为低血小板血症（OR=0．170，95％CI0．051～0．56）及LN复发（OR=0．144，95％CI0．025～0．841）（P均〈0．05）；胎儿或新生儿不良结局发生的相关因素为孕妇发生子痫前期（OR=0．122，95％CI 0．029～0．513）和孕妇LN疾病活动期（OR=0．028，95％CI 0．006～0．135）（P均〈0．05）。结论LN孕妇在妊娠前期或妊娠期疾病处于活动期会增加母婴不良结局的发生，故临床上应建议LN的年轻妇女选择病情稳定期妊娠，并在妊娠期间严密监测孕妇的尿蛋白、血小板、补体及肾功能等指标，及时发现LN活动并尽早治疗。Objective： To analyze the related factors of adverse pregnancy outcomes in the women with lupus nephritis. Methods： The data of 117 pregnancies in 111 patients with lupus nephritis in our hospital from December 10, 2000 to December 31 2013 were retrospectively analyzed. The patients were divided into two groups according to the condition of lupus nephritis before pregnancy： stable condition group（78 patients）and active condition group（39 patients）. The adverse maternal outcomes included the disease condition worsened,increase of urine protein content and renal damage aggravation during pregnancy or after delivery, preeclampsia, thrombocytopenia, hypo- complementemia. The fetus and newborn adverse outcomes included termination of pregnancy due to treatment requirement,fetal loss,premature birth,low birth weight,neonatal asphyxia and neonatal death. Statistical analysis was performed with Chi-square test. A binary logistic regression model was used to evaluate the risk factors for adverse maternal and fetal outcomes. Results： No significant difference of the maternal adverse outcomes was found between the stable and active group（P〉0.05）. The adverse outcome of fetus and newborn in the active group were significantly higher than that in the stable group（χ2=20.22,P〈0.001）. Among them,termination of pregnancy for treatment requirement was significantly higher than that in the stable group（χ2=16.71, P〈0. 001）. The premature birth rate in active group was significantly higher than that in the stable group（χ2= 5.14, P= 0. 023）,and the mortality of fetus and newborn was significantly higher than that in the stable group（χ2=9. 54,P =0. 002）. Binary logistic regression analysis showed that the risk factors of the disease exacerbated during pregnancy were thrombocytopenia （OR ： 0. 303,95 % CI： 0. 125-0. 736） and hypo-complementemia （OR = 0. 056, 95% CI：0. 006-0. 507）. The risk factors for preeclampsia in LN pregnant women were thrombocytopenia（OR= 0. 170,95%CI：

关 键 词：系统性红斑狼疮 狼疮肾炎 妊娠不良结局 子痫前期 

分 类 号：R[医药卫生]