羟氯喹联合泼尼松治疗对妊娠合并系统性红斑狼疮患者母婴结局的影响  

Effect of hydroxychloroquine combined with prednisone on maternal and infant outcome in pregnancy complicated with systemic lupus erythematosus

作　　者：覃纬 李敏清[2] Qin Wei;Li Minqing(Department of Obstetrics,Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541002,China;Department of Prenatal Diagnosis and Genetic Disease Diagnosis,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西壮族自治区南溪山医院产科,桂林541002 [2]广西医科大学第一附属医院产前诊断与遗传病诊断科,南宁530021

出　　处：《中华生物医学工程杂志》2021年第6期621-628,共8页Chinese Journal of Biomedical Engineering

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2017074)。

摘　　要：目的应用Meta分析方法对比羟氯喹联合泼尼松与单一使用泼尼松或单一羟氯喹治疗对妊娠合并系统性红斑狼疮(SLE)患者母婴结局的影响。方法通过计算机检索中国知网(CNKI)、维普(VIP)、万方数据库、Pubmed、SinoMed、Embase、Cochrane Library等数据库中对比分析羟氯喹联合泼尼松治疗(研究组)与单一使用泼尼松治疗或单一使用羟氯喹治疗(对照组)对妊娠合并SLE母婴结局影响的随机对照研究或对照试验。检索时间为各库建立时间至2021年5月,应用Cochrane风险评价表评价纳入研究的偏倚风险,采用Stata 13.1进行Meta分析。结果最终纳入研究文献共8篇、研究对象共602例(其中对照组287例、研究组315例),分析显示研究组的狼疮活动率明显低于对照组(OR=0.32,95%CI:0.16~0.63,P<0.01);研究组妊娠早期SLEDAI评分与对照组比较,差异无统计学意义(MD=-0.17,95%CI:-0.68~0.34,P=0.51);研究组妊娠中期SLEDAI评分显著低于对照组(MD=-2.02,95%CI:-2.48~-1.55,P<0.01);研究组妊娠晚期SLEDAI评分显著低于对照组(MD=-2.66,95%CI:-3.00~-2.31,P<0.01);研究组治疗过程中不良反应发生率低于对照组(OR=0.53,95%CI:0.30~0.95,P=0.03);研究组终止妊娠率明显低于对照组(OR=0.33,95%CI:0.18~0.60,P<0.01);研究组足月妊娠发生率明显高于对照组(OR=3.66,95%CI:2.30~5.82,P<0.01);研究组早产发生率显著低于对照组(OR=0.36,95%CI:0.20~0.64,P<0.01);研究组的新生儿出生体质量显著高于对照组(MD=276.40,95%CI:56.96~495.85,P=0.01);研究组的新生儿出生5 min Apgar评分与对照组比较,差异无统计学意义(MD=0.12,95%CI:-0.05~0.28,P=0.16);研究组的新生儿窒息发生率与对照组比较,差异无统计学意义(MD=0.23,95%CI:0.05~1.12,P=0.07)。结论羟氯喹联合泼尼松治疗妊娠合并SLE较单一使用泼尼松治疗效果更好,可有效控制狼疮病情活动,改善不良妊娠结局,提高新生儿出生体质量,降低治疗过程中不良反应的发生。Objective To compare the effects of hydroxychloroquine combined with prednisone,and single use of prednisone or hydroxychloroquine,on maternal and infant outcome in pregnancy complicated with systemic lupus erythematosus(SLE)using a meta-analytic approach.Methods A computer search of CNKI,VIP,Wanfang database,Pubmed,SinoMed,Embase,and Cochrane Library were used to retrieve and compare randomized controlled studies or controlled trials on the effect of hydroxychloroquine combined with prednisone(study group),prednisone or hydroxychloroquine alone(control group)on maternal and infant outcomes in pregnancy with SLE.The search time ranged from the inception of each database to May 2021.Cochrane risk of bias tool was used to evaluate the risk of bias in the included studies.Stata 13.1 was used for meta-analysis processing.Results A total of 8 research articles comprising 602 subjects were included(287 in the control group and 315 in the study group).Our meta-analysis showed that the SLE activity in the study group was significantly lower than that in the control group(OR=0.32,95%CI:0.16 to 0.63,P<0.01).The SLEDAI score was not statistically different between the study group and the control group during first trimester(MD=-0.17,95%CI:-0.68 to 0.34,P=0.51),but was significantly lower in the study group during the second trimester(MD=-2.02,95%CI:-2.48 to-1.55,P<0.01)and the third trimester(MD=-2.66,95%CI:-3.00 to-2.31,P<0.01)of pregnancy in the study group compared with the control group.The incidence of adverse reactions during treatment was lower in the study group than that in the control group(OR=0.53,95%CI:0.30 to 0.95,P=0.03).Compared with the control group,the study group presented significantly lower rate of pregnancy termination rate(OR=0.33,95%CI:0.18 to 0.60,P<0.01),higher rate of full-term pregnancy(OR=3.66,95%CI:2.30 to 5.82,P<0.01),lower rate of preterm birth(OR=0.36,95%CI:0.20 to 0.64,P<0.01),and higher birth weight of the newborns(MD=276.40,95%CI:56.96 to 495.85,P=0.01).There were no statistically differe

关 键 词：羟氯喹 泼尼松 妊娠 系统性红斑狼疮 母婴结局 

分 类 号：R714.25[医药卫生—妇产科学]