国际妇产科学杂志

国际妇产科学杂志 ›› 2017, Vol. 44 ›› Issue (1): 95-98.

• 论著 • 上一篇    下一篇

妊娠合并系统性红斑狼疮61例临床分析

邓冉冉1,2,李增彦2   

  1. 1. 天津医科大学
    2. 天津医科大学总医院
  • 收稿日期:2016-11-18 修回日期:2017-01-20 出版日期:2017-02-15 发布日期:2017-03-28
  • 通讯作者: 李增彦 E-mail:li_zengyan@sina.com

The Clinical Analysis of 61 Pregnancies with Systemic Lupus Erythematosus

Ran-ran DENG1,1,   

  • Received:2016-11-18 Revised:2017-01-20 Published:2017-02-15 Online:2017-03-28

PDF (PC)

6813

摘要： 【摘要】 目的：探讨系统性红斑狼疮(SLE)对妊娠并发症、妊娠结局、分娩方式的影响。方法：回顾性分析天津医科大学总医院自2010年1月1日至2015年12月31日收治的61例妊娠合并SLE患者的临床资料，根据SLE妊娠时机及孕前临床表现、实验室检查等分为SLE稳定组(35例)和SLE活动组（26例）。结果：①在妊娠并发症方面，SLE病情活动组子痫前期的发生率显著高于稳定组（58% vs 0，P=0.000），其他并发症胎膜早破、胎儿宫内窘迫、胎儿宫内生长受限、产后出血、羊水少的发生率差异均无显著性（P>0.05）。②在妊娠结局及分娩方式方面，SLE活动组早产（50% vs 20%，P=0.014）、低出生体重儿（50% vs 20%，P=0.014）、中期引产（27% vs 3%，P=0.018）的发生率均显著高于SLE稳定组。但早产低出生体重儿与足月产低出生体重儿之间（P=0.270）差异无显著性。SLE活动组自然分娩率明显低于稳定组（0 vs 43%，P=0.000）。SLE活动组死胎、自然流产史、胚胎停育史、新生儿狼疮、剖宫产的发生率差异均无显著性（P>0.05）。③孕期发现的4例SLE病人，其中2例是由于反复的胎心波动于115～125bpm之间，我院风湿科门诊就诊，确诊为狼疮。结论：SLE孕产妇属于高危患者，SLE合并妊娠病情活动时，子痫前期、早产、低出生体重儿、中期引产的发生率较稳定期明显增高，因此SLE患者在孕期应密切监测患者SLE临床表现，血压、以及尿蛋白、肝肾功能、免疫学指标等实验室检查，及时发现SLE病情活动情况，及时处理，以减少妊娠并发症及不良结局的发生率。值得注意的是孕期发生子痫前期应排除狼疮，对于孕期反复胎心率低的孕产妇，也应警惕合并狼疮。

关键词: 妊娠, 系统性红斑狼疮, 妊娠并发症, 妊娠结局, 分娩方式

Abstract: Objective: To explore the systemic lupus erythematosus with respect to obstetric complications, pregnant outcomes and the manner of delivery. Methods: we reviewed the medical records of SLE pregnant women treated from January 1, 2010 to December 31, 2015 in Tianjin medical university general hospital. According to clinical manifestation, laboratory examination, drug treatment during pregnancy, the patients is divided into the stability of SLE group (35 cases) and SLE activity group (26cases). Results: In terms of pregnancy complications, the incidence of preeclampsia in SLE disease activity group was obviously higher than that in the stability of SLE group（58% vs 0，P=0.000）. The incidence of other complications of premature rupture of membranes, fetal distress, fetal intrauterine growth restriction, postpartum hemorrhage, and oligohydramnios has no statistically significant difference between two groups (P > 0.05). In expect of pregnant outcomes and the manner of delivery, the incidence of prematurity（50% vs 20%，P=0.014）,low birth weight infant（50% vs 20%，P=0.014）, therapeutic abortion（27% vs 3%，P=0.018）in SLE disease activity group was obviously higher than that in the stability of SLE group. However, there has no statistically significant difference between low birth weight infant with preterm birth and low birth weight infant with term birth. The incidence of stillbirth, spontaneous, embryonic development stopping, Neonatal lupus, and cesarean delivery has no statistically significant difference between two groups (P > 0.05). Two patients from four patients with SLE found in pregnancy were diagnosed with lupus in the department of rheumatology clinic due to repeated fetal heart rate fluctuation between 115 ~ 125bpm. Conclusions: Preganat women with SLE are high-risk patients. The incidence of preeclampsia, prematurity, low birth weight infant, therapeutic abortion is high in SLE activity. Pregnancy should be planned after remission for more than six months. Clinical manifestations, blood pressure, and laboratory examination, such as urinary protein, kidney function, immunological indexes, should be closely monitoring during pregnancy. So, we can find SLE disease activity timely and timely treatment in order to reduce the incidence of pregnancy complications and adverse outcomes. It is worth noting that preeclampsia occuring during pregnancy should be be distinguished with lupus and for repeated low heart rate of maternal pregnancy, should also be alert to merge lupus and the repeated slow fetal heart rate during pregnancy should be alert to the lupus.

Key words: Pregnancy, Systemic lupus erythematosus, Obstetric complications, Pregnant outcomes, Manner of delivery