未分化结缔组织病与反复妊娠丢失的研究进展

doi:10.12280/gjfckx.20201134

摘要/Abstract

摘要：

反复妊娠丢失（recurrent pregnancy loss,RPL）是未分化结缔组织病（undifferentiated connective tissue disease,UCTD）一个常见且重要的临床表现,UCTD则是RPL一个隐匿且极为关键的免疫学病因。UCTD患者罹患RPL的风险显著增加,RPL人群合并UCTD的风险同样增加。对于妇产科和风湿免疫科医生均应重视RPL人群中UCTD的筛查和诊断,主要包括UCTD相关症状体征及血清抗核抗体、抗可提取性核抗原抗体和抗磷脂抗体等自身抗体指标的筛查。对于筛查确诊为UCTD的RPL患者在备孕期间应转诊风湿免疫科,给予规范化免疫干预治疗,UCTD患者应在免疫状态稳定后再妊娠,并由妇产科和风湿免疫科医生开展多学科合作全程参与UCTD合并RPL患者的妊娠期、分娩期及产后规范化监测和管理,以减少RPL和母儿不良妊娠结局的发生,还可降低UCTD疾病复发和进展的风险,保障母儿安全。

关键词: 胚胎丢失, 结缔组织疾病, 自身免疫, 抗体,抗核, 妊娠, 诊断

Abstract:

Recurrent pregnancy loss (RPL) is a common and important clinical manifestation of undifferentiated connective tissue disease (UCTD), while UCTD is a hidden and extremely important immunological etiology of RPL. UCTD patients have a significantly increased risk of RPL, and the risk of UCTD in the RPL population also increases. Therefore, obstetrician and gynecologist as well as rheumatologist should pay attention to the screening and diagnosis of UCTD in the RPL population, especially the symptoms and signs related to UCTD and the screening of antinuclear antibodies, anti-extractable nuclear antigen antibodies, antiphospholipid antibodies and so on. For RPL patients diagnosed with UCTD, they should be referred to the rheumatology department during the pre-pregnancy period and standardized immune intervention therapy should be given to make sure they have stable immune status before pregnancy. Obstetrician and gynecologist as well as rheumatologist should carry out multidisciplinary cooperation to participate in the standardized monitoring and management of patients with both UCTD and RPL during their pregnancy, delivery and postpartum period, which will reduce the incidence of RPL and the adverse pregnancy outcomes and the risks of recurrence and progression of UCTD disease, ensure the safety of mother and child at the same time.

Key words: Embryo loss, Connective tissue diseases, Autoimmunity, Antibodies,antinuclear, Pregnancy, Diagnosis

张钰, 徐玲. 未分化结缔组织病与反复妊娠丢失的研究进展[J]. 国际妇产科学杂志, 2021, 48(4): 385-389.

ZHANG Yu, XU Ling. Research Progress of Undifferentiated Connective Tissue Disease and Recurrent Pregnancy Loss[J]. Journal of International Obstetrics and Gynecology, 2021, 48(4): 385-389.

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