妊娠新发系统性红斑狼疮患者的临床特征及母儿结局分析  

Clinical characteristics and maternal and fetal outcomes of patients with new-onset systemic lupus erythematosus during preg-nancy

作　　者：吕加敏 徐力[2] 易善玲 吴寒冰[1] 艾玲[1] 余一美 LYU Jiamin;XU Li;YI Shanling;WU Hanbing;AI Ling;YU Yimei(Department of Obstetrics,Jiaxing Municipal Maternal and Child Health Care Hospital,Jiaxing 314051,China)

机构地区：[1]嘉兴市妇幼保健院产科,314051 [2]嘉兴市妇幼保健院内科,314051

出　　处：《浙江医学》2022年第19期2070-2074,共5页Zhejiang Medical Journal

基　　金：嘉兴市科技计划项目(2019AD32077)。

摘　　要：目的探讨妊娠新发系统性红斑狼疮(SLE)患者的临床特征及SLE对母儿结局的影响。方法选取2011年1月至2021年12月嘉兴市妇幼保健院收治的单胎妊娠合并SLE患者88例。按照SLE发病时间分为孕期新发组(16例)和孕前诊断组(72例),比较两组患者临床表现、SLE病情活动指数(SLEPDAI)、妊娠并发症、母儿结局、妊娠期用药情况。结果妊娠新发组SLEPDAI高于孕前诊断组[5.5(3,7.75)比4(2,5),P<0.05]。妊娠新发组子痫前期、早产发生率均高于孕前诊断组(40.00%比11.59%、46.67%比20.29%,均P<0.05]。两组患者分娩孕周,狼疮性肾炎、胎盘早剥、胎膜早破、血小板减少症、胎儿生长受限、羊水过少、胎儿窘迫、产后出血发生率,剖宫产分娩占比比较差异均无统计学意义(均P>0.05)。妊娠新发组患者新生儿出生体重低于孕前诊断组[(2466.67±618.65)g比(2838.28±529.44)g,P<0.05],未足月低出生体重儿、入住NICU占比均高于孕前诊断组(40.00%比15.94%、53.33%比21.74%,均P<0.05)。两组患儿足月低体重儿占比比较差异无统计学意义(P>0.05)。妊娠新发组患者使用羟氯喹占比高于孕前诊断组(93.75%比66.67%,P<0.05),而两组患者使用>15 mg/d的糖皮质激素、免疫抑制剂、抗凝药(阿司匹林或低分子肝素)的占比比较差异均无统计意义(均P>0.05)。结论与孕前诊断为SLE的患者相比,妊娠新发SLE的患者子痫前期、早产、未足月低体重儿及新生儿入住NICU的发生风险更高,应重视孕期SLE的筛查和多学科治疗,规范产检和有效干预以改善妊娠结局。Objective To analyze the clinical characteristics,and maternal/fetal outcomes in pregnant women with new-onset systemic lupus erythematosus(SLE).Methods Eighty-eight women with singleton pregnancy complicated with SLE admitted to Jiaxing Municipal Maternal and Child Health Hospital from January 2011 to December 2021 were enrolled,including 16 cases of SLE diagnosed during pregnancy(new-onset group)and 72 cases with SLE.diagnosed before preg-nancy(pre-pregnant group).The clinical manifestations,SLE disease activity index(SLEPDAI),pregnancy complications,ma-ternal and fetal outcomes,medication during pregnancy were compared between the two groups.Results The SLEPDAI in the new-onset SLE group was higher than that in the pre-pregnancy group[5.5(3,7.75)vs.4(2,5),P<0.05].The inci-dence of preeclampsia and preterm delivery in new-onset SLE group was higher than that in pre-pregnancy SLE group(40.00%vs.11.59%and 46.67%vs.20.29%,all P<0.05).There was no significant difference in the incidence of gestation-al age at delivery,lupus nephritis,placental abruption,premature rupture of membranes,thrombocytopenia,fetal growth restriction,oligohydramnios,fetal distress,cesarean delivery and postpartum hemorrhage(all P>0.05).The neonatal birth weight in the new-onset pregnancy group was lower than that in the pre-pregnancy group[(2466.67±618.65)g vs.(2838.28±529.44)g,P<0.05],and the incidence of preterm low birth weight infants and NICU admission was higher than that in the pre-pregnancy group(40.00%vs.15.94%,53.33%vs.21.74%,P<0.05).There was no significant difference in the incidence of full-term low birth weight infants between the two groups(P>0.05).The utilization rate of hydroxychloro-quine in new-onset SLE group was higher than that in pre-pregnancy group(93.75%vs 66.67%,P<0.05),but there were no significant differences between the two groups in the use rate of glucocorticoids(>15 mg/d),immunosuppressants and anticoagulants(aspirin or low molecular weight heparin)(all P>0.05).Conclusion Compared with patients with SLE dia

关 键 词：系统性红斑狼疮 妊娠 新发 妊娠结局 

分 类 号：R714.259[医药卫生—妇产科学]