妊娠合并系统性红斑狼疮母胎结局的分析

发布时间：2018-04-13 20:13

本文选题：妊娠 + 系统性红斑狼疮　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:通过分析SLE疾病状态对产科并发症、妊娠结局、分娩方式的影响,以及用药情况、有无既往不良妊娠史对妊娠结局影响,探讨妊娠合并SLE患者的受孕时机、孕期监测及产后管理,预防疾病恶化及不良母胎结局的发生。方法:本文采用回顾性研究的方法,通过收集2010年1月1日至2016年12月31日天津医科大学总医院收治的资料完整的84例妊娠合并SLE患者,分析患者的产科并发症(PIH、FGR、胎儿窘迫)和妊娠结局(妊娠丢失、早产、足月产)。主要分为以下4组进行研究:(11)根据患者受孕时疾病的状态将84例SLE患者分为孕前SLE稳定组55例(A组)和孕前SLE活动组29例(B组);(12)根据孕期SLE病情状态将84例SLE患者分为孕期SLE稳定组46例(C组)与孕期SLE活动组38例(D组);(13)根据用药类型将84例SLE患者分为3组,仅使用激素62例(E组),激素联合羟氯喹17例(F组),激素联合阿司匹林和(或低分子肝素)5例(G组);(14)根据既往有无不良妊娠史(包括流产、死胎、胚胎停育等)将84例SLE患者分为2组。采用SPSS19.0软件进行统计学分析(P0.05表示差异有统计学意义)。结果:(1)妊娠合并SLE患者共计84例,均为自然受孕,均为单胎。年龄平均29.89±4.27(范围21-41)岁,病程平均4.89±3.82(范围0-16)年,分娩孕周平均35.35±6.14(范围16-40~(+6))周。孕期初发患者6例(7.1%);SLE合并APS6例(7.1%);狼疮肾炎的患者7例(8.3%)。(2)SLE病情对妊娠结局的影响:84例SLE患者妊娠丢失11例(13.1%);妊娠成功73例(86.9%),包括早产23例(27.4%),足月产50例(59.5%)。无论是孕前稳定组还是孕期稳定组,妊娠丢失、早产的发生率均显著低于活动组,足月产的发生率显著高于活动组(P0.05)。(3)SLE病情对产科并发症的影响:84例SLE患者中孕前稳定组和活动组分别55例(65.5%)和29例(34.5%),孕期稳定组和活动组分别有46例(54.8%)和38例(45.2%)。PIH23例(27.4%)。孕前SLE稳定组PIH发生率显著低于活动组(P0.05),而FGR、PROM、胎儿窘迫差异均无统计学意义(P0.05);孕期活动组PIH、FGR的发生率均显著高于稳定组(P0.05),而PROM与胎儿窘迫二组比较差异无统计学意义(P0.05)。(4)84例SLE患者中剖宫产56例(66.7%),阴道顺产18例(21.4%),中期引产10例(11.9%)。无论孕前还是孕期稳定组,剖宫产的发生率均和活动组无显著差异(P0.05)。早产剖宫产21例,以“PIH/HELLP综合征”为手术指征11例(52.4%)。(5)用药情况对妊娠结局的影响:仅使用激素、激素联合羟氯喹、激素联合阿司匹林和(或)低分子肝素,三组之间两两比较,妊娠丢失、早产、足月产的发生率差异均无统计学意义(P0.05)。(6)84例SLE患者有既往不良妊娠史(包括流产、死胎、胚胎停育等)共有43例,占51.2%(43/84)。在有、无既往不良妊娠史二组比较中,妊娠丢失、早产、足月产的发生率差异均无统计学意义(P0.05)。结论:(1)SLE孕产妇应加强产科、风湿免疫科、ICU、心内科等多科室共同监测,共同管理,改善母胎结局(2)SLE孕产妇属于高危患者,易发生不良妊娠结局,并且妊娠期间易复发。但是,通过产科、风湿免疫科等多科室共同管理,可获得较高的妊娠成功率。(3)受孕时SLE疾病的状态与母胎结局密切相关,SLE患者应在稳定期受孕,以提高妊娠成功率,减少产科并发症。(4)PIH是SLE疾病活动主要并发症,与不良妊娠结局密切相关。(5)SLE可导致胎儿先天性损害,特别是心脏传导阻滞,要加强孕早期筛查,及时干预。
[Abstract]:Objective : To investigate the effect of SLE disease state on pregnancy outcome , pregnancy outcome and delivery mode , as well as the effect of medication on pregnancy outcome , and to explore the timing of pregnancy , pregnancy monitoring and postpartum management to prevent the occurrence of disease worsening and adverse maternal fetal outcomes . Methods : The clinical complications ( PIH , FGR , fetal distress ) and outcome of pregnancy ( loss of pregnancy , premature delivery and full term birth ) were analyzed by collecting 84 cases of pregnancy complicated with SLE . Eighty - four patients with SLE were divided into two groups ( group A ) and active SLE group ( group B ) according to the state of the disease during pregnancy . The results were as follows : ( 1 ) There were 84 SLE patients divided into 3 groups : the average age was 29.89 卤 4.27 ( range 21 - 41 ) years , the duration of pregnancy was 4.89 卤 3.82 ( range 0 - 16 ) years , the incidence of pregnancy was significantly lower than that in the active group ( P < 0.05 ) . ( 4 ) The incidence of PIH and FGR in patients with SLE was significantly lower than that in the active group ( P0.05 ) . Conclusion : ( 1 ) There are 43 cases in SLE patients with past adverse pregnancy history ( including abortion , stillbirth , embryo arrest , etc . ) , accounting for 51.2 % ( 43 / 84 ) .

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.25

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