妊娠初发系统性红斑狼疮患者的临床特征及不良妊娠结局分析
Clinical features and adverse pregnancy outcomes of new onset systemic lupus erythematosus during pregnancy
目的 探讨妊娠初发系统性红斑狼疮(SLE)患者的临床特点和妊娠结局.方法 收集2001至2015年中山大学附属第一医院收治的263例次SLE合并妊娠的临床资料进行回顾性分析.结果 妊娠初发SLE者75例,既往已诊断SLE者188例次.妊娠初发SLE者中72例为妊娠过程中诊断,其中孕早期27例(37.5%),孕中期31例(43.1%),孕晚期14例(19.4%),另外3例为产褥期诊断SLE.妊娠初发SLE有81.3%的患者处于活动期,最常见临床表现为狼疮肾炎(57.3%)和血小板减少(38.7%).妊娠初发SLE的妊娠期狼疮病情活动指数(SLEPDAI)、狼疮肾炎和血小板减少发生率均高于非妊娠初发组(P<0.05).75例妊娠初发SLE中,53例出现不良妊娠结局,包括34例妊娠丢失,15例早产,8例宫内发育迟缓,5例胎儿宫内窘迫,5例新生儿狼疮.与非妊娠初发SLE比较,妊娠初发SLE组的不良妊娠结局发生率高(56.4%比70.7%,P<0.05),妊娠丢失率高(21.8%比45.3%,P<0.01)、活胎分娩率低(78.2%比54.7%,P<0.01).结论 妊娠初发SLE多发生于孕早、中期,最常见的临床表现为狼疮肾炎和血小板减少.与非妊娠初发SLE患者相比,妊娠初发SLE患者活动度高,狼疮肾炎、血小板减少发生率高,不良妊娠结局和妊娠丢失率高.
更多Objective To investigate the clinical characteristics and adverse pregnancy outcomes in pregnant women with new onset systemic lupus erythematosus (SLE) during pregnancy.Methods The clinical data of 263 pregnancies with SLE in the First Affiliated Hospital of Zhongshau University from 2001 to 2015 were collected and analyzed retrospectively.Results Of all the 263 pregnancies,188 were diagnosed before pregnancy and 75 were newly diagnosed during pregnancy.Among the 75 new onset SLE,27,31,14 and 3 cases were diagnosed during first trimester,second trimester,third trimester and puerperium,respectively.Active lupus was noted in 81.3% of the patients with new onset SLE.The main clinical manifestations of new onset SLE were lupus nephritis (57.3%) and thrombocytopenia (38.7%).SLEPDAI scores as well as the prevalence of lupus nephritis,and thrombocytopenia in patients with new onset SLE was higher than those in the previously diagnosed ones (P < 0.05).Among the 75 new onset SLE pregnancies,adverse pregnancy outcomesoccurred in 53 patients,including 34 with pregnancy loss,15 with premature,8with intrauterine growth restriction,Swith fetal distress and5 with neonatal lupus.Compared with patients withnon-newonset SLE,patients with newonset SLEhad a higher prevalence of adverse pregnancy outcomes (56.4% vs 70.7%,P <0.05),and pregnancy loss (21.8% vs 45.3%,P <0.01) but less live birth (78.2% vs 54.7%,P < 0.05).Conclusion Most of the patients with new onset SLE occurred during the first and second trimester.The most common clinical features of new onset SLE were lupus nephritis and thrombocytopenia.Patients with new onset SLE were more prone to active lupus,lupus nephritis and thrombocytopenia,as well as more adverse pregnancy outcomes and pregnancy loss.
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