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目的探讨妊娠合并系统性红斑狼疮(SLE)患者孕期病情活动情况,及其与妊娠结局、产科并发症的关系。方法对2006～2011年收治的51例次妊娠合并SLE的49名患者临床资料进行回顾性分析。结果①根据SLE活动与否分为A组和B组:临床无SLE活动,妊娠前1年不用糖皮质激素或泼尼松剂量≤10 mg/d为A组;妊娠前1年内有SLE活动,或妊娠过程SLE首次发病及SLE病情加重为B组。A组患者仅发生微量蛋白尿1例和中度贫血2例;B组以妊娠中期SLE首发及病情加重为主,主要损害肾脏和血液系统;并发生产妇死亡一例及重度先兆子痫7例。②A组胎儿丢失率(9.1%)明显小于B组(42.5%),早产(20%)和低体重率(27.3%)明显低于B组(分别为60.9%、65.2%),A组新生儿体重明显大于B组,分别为(2661±699)g、(2268±849)g,P均<0.05。结论孕前病情不稳定、孕期泼尼松用药不规范是妊娠合并SLE病情加重的危险因素。不良妊娠结局在孕期SLE活动时明显增加。
Objective To investigate the status of disease activity in pregnancy with systemic lupus erythematosus (SLE) and its relationship with pregnancy outcome and obstetric complications. Methods The clinical data of 51 patients with pregnancy complicated with SLE from 2006 to 2011 were analyzed retrospectively. Results ①According to the SLE activity or not, the patients were divided into A group and B group: there was no clinical SLE activity, no glucocorticoid or prednisone dose ≤10 mg / d in group A before pregnancy, group A; SLE activity within 1 year before pregnancy, Or the first incidence of SLE during pregnancy and SLE exacerbations for the B group. In group A, only one case of microalbuminuria and two cases of moderate anemia were observed. In group B, the first trimester of SLE and exacerbations were the main cause of the second trimester pregnancy, which mainly damaged the kidneys and blood system. One case of maternal death and 7 cases of severe preeclampsia occurred. ② The fetal loss rate (9.1%) in group A was significantly lower than that in group B (42.5%), the preterm birth rate (20%) and low weight rate (27.3%) were significantly lower than those in group B (60.9% and 65.2% The body weight was significantly higher than that in group B (2661 ± 699) g and (2268 ± 849) g, respectively, P <0.05. Conclusions Pre-pregnancy condition is unstable, and the non-standard prednisone during pregnancy is a risk factor for the aggravation of SLE during pregnancy. Adverse pregnancy outcomes significantly increased during SLE activity during pregnancy.