40例孕期初发系统性红斑狼疮患者的临床研究

发布时间：2018-05-30 02:17

本文选题：系统性红斑狼疮 + 妊娠　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：探讨我院近10年来住院诊治的40例孕期初发SLE患者的发病年龄、病程、首发症状、系统受累等临床特征，实验室检查结果及疾病的治疗与转归，以期能为该病的临床诊疗提供一定的参考。方法：对2004年1月至2013年9月在广西医科大学第一附属医院住院诊治的40例孕期初发系统性红斑狼疮患者的临床资料进行回顾性分析。按年龄匹配随机抽取60例同期住院诊治的非孕期初发SLE患者的临床资料作为对照组，该组患者需满足近12个月来无妊娠史。将40例孕期初发SLE患者按有无肾脏受累情况分为A组（肾脏受累患者）和B组（无肾脏受累患者）两个亚组。记录其发病年龄（首次出现症状的年龄）、病程（第一次出现症状到来就诊的时间）、发病所处的妊娠阶段（详见附表3）、孕周（第一次出现症状时的妊娠周数）、产妇类型（初产妇或经产妇）、首发症状、系统受累及实验室检查结果、肾穿刺活检结果、妊娠结局及疾病治疗与转归。观察组和对照组进行组间比较，观察组两亚组分别进行组内比较。采用SPSS16.0软件处理数据，正态分布计量资料采用均数±标准差描述，t检验分析；非正态分布、方差不齐的数据使用中位数、四分位数间距描述，Mann-Whitney U检验。计数资料采用百分率描述，χ2检验分析。所有结果均以P＜0.05为差异有统计学意义。结果： 1.近10年来，在我院住院诊治的SLE合并妊娠患者共132例，其中40例患者在妊娠期或产褥期首次诊断了SLE，所占比例达30.1%。40例孕期初发SLE患者的发病年龄平均为（26.4±4.2）岁。绝大多数患者（占85%）的发病出现在妊娠的早期和中期。40例患者的妊娠结局不容乐观，其中高达27.5%的患者出现胎儿质量异常，包括宫内死胎6例、胎儿畸形2例、难免流产2例，自然流产1例；而选择人工终止妊娠的比例则高达47.5%。 2.孕期初发SLE患者的病程长短不一，但均在6个月以内，最短为3天，较同期住院诊治的非孕期初发SLE患者短。 3.所有患者的首发症状均以皮肤红斑、关节炎和/或关节痛多见。观察组患者则更容易出现面部和/或双下肢水肿。 4.两组患者的系统受累个数、SLEDAI评分差异无统计学意义，即孕期初发SLE患者与非孕期初发患者狼疮病情活动度基本相近。但是，孕期初发SLE患者往往更容易出现肾脏损害，，而出现全身症状如乏力、发热等及关节肌肉病变则相对要少。 5.观察组患者白细胞计数总体水平高于对照组，而血红蛋白、血清白蛋白水平及免疫球蛋白三项IgG、IgA、IgM水平则总体低于对照组。两组患者血清补体、血沉及C-反应蛋白差异无统计学意义。 6.高达55%的观察组患者出现肾脏损害，所占比例明显高于对照组。两组患者尿常规检查中反映肾脏病变活动的指标差异无统计学意义，但是观察组患者的24小时尿蛋白定量高于对照组，且更容易出现24小时尿蛋白定量大于0.5g。因此，孕期初发SLE患者当肾脏受累时，临床类型易出现肾病综合征型，而较少出现慢性肾炎型。 7.观察组组内两个亚组中，A组系统受累个数增多，狼疮病情活动度更高，更容易出现严重贫血，血沉加快也更明显，补体C3下降更严重。 8.无论是观察组与对照组的比较，还是观察组两个亚组之间的比较，自身抗体阳性率、抗ds-DNA抗体滴度，差异均无统计学意义。 9.经治疗后，尽管高达81.8%的观察组患者病情可好转，但是观察组患者总的好转率仍然低于对照组，提示观察组患者预后较差。结论： 1.孕期初发SLE患者倾向于在妊娠的早期和中期发病。 2.不良妊娠结局在孕期初发SLE患者身上发生率高。 3.妊娠期初发的SLE更容易累及肾脏；当肾脏受累时，患者临床表现以肾病综合征型多见，而较少出现慢性肾炎型。 4.大多数孕期初发SLE患者经治疗后病情可好转，其预后相对较差。
[Abstract]:Objective : To explore the clinical characteristics of 40 cases of SLE who were hospitalized in the past 10 years in our hospital , including the age , the course , the symptoms of the first episode , the system ' s involvement and so on . The results of the laboratory examination and the treatment and prognosis of the disease were discussed in order to provide some reference for the clinical diagnosis and treatment of the disease .

Methods : The clinical data of 40 patients with SLE who were hospitalized in the first Affiliated Hospital of Guangxi Medical University from January 2004 to September 2013 were analyzed retrospectively .
The data of non - normal distribution and variance was described by median , quartile range description , Mann - Whitney U test . The count data was described by percentage , 蠂2 test analysis . All results were statistically significant at P & lt ; 0.05 .

Results :

1 . In recent 10 years , 132 cases of SLE complicated with pregnancy were diagnosed and treated in our hospital . Among them , 40 patients were diagnosed with SLE at the first time during pregnancy or during the perium perium period . The average age of the 40 patients ( 85 % ) was ( 26 . 4 卤 4.2 ) years . Most of the 40 patients ( 85 % ) had abnormal fetal quality , including 6 cases of intrauterine fetal death , 2 cases of fetal malformation , 2 cases of inevitable abortion and 1 case of spontaneous abortion .
The proportion of artificial termination of pregnancy was up to 47.5 % .

2 . The duration of the onset of SLE in the first trimester of pregnancy was short , but within 6 months , the shortest was 3 days , and the patients with SLE who were hospitalized for the same period were shorter than those who were hospitalized in the same period .

3 . The initial symptoms of all patients were observed with erythema , arthritis and / or arthralgia in the skin . Patients in the observation group were more likely to develop facial and / or bilateral lower extremity edema .

4 . There was no significant difference in SLEDAI score between the two groups , that is , the activity of SLE patients with SLE was similar to that of non - pregnant first - onset SLE patients . However , the patients with SLE tended to be more prone to kidney damage , while systemic symptoms such as hypodynamia , fever , and joint muscle diseases were relatively few .

5 . The overall level of white blood cell count in the observation group was higher than that in the control group , while the levels of hemoglobin , serum albumin and immunoglobulin IgG , IgA and IgM were lower than those in the control group . There was no significant difference in serum complement , ESR and C - reactive protein in the two groups .

6 . There was no significant difference in the indexes of renal lesion in the observation group with up to 55 % , but the 24 - hour urinary protein in the observation group was higher than that of the control group , and the 24 - hour urinary protein was more likely to be more than 0.5g . Therefore , when the kidney was tired , the clinical type was easy to develop nephrotic syndrome type , and the chronic nephritis type was less .

7 . In the two subgroups in the group , the number of patients in group A was increased , the activity of lupus was higher , severe anemia was more likely to occur , the ESR was faster , and the C3 of complement C3 was more severe .

8 . Whether the comparison between the observation group and the control group , or the comparison between the two subgroups in the observation group , the positive rate of the autoantibodies and the anti - ds - DNA antibody titer were not statistically significant .

9 . After treatment , the overall improvement rate in the observation group was still lower than that of the control group , although the improvement rate was 81.8 % in the observation group , and the prognosis was poor in the observation group .

Conclusion :

1 . At the beginning of pregnancy , SLE patients tend to be in the early and middle stages of pregnancy .

2 . The incidence of adverse pregnancy outcome was high in SLE patients during pregnancy .

3 . SLE is more likely to involve the kidney during pregnancy .
When the kidneys are involved , the clinical manifestations of the patients are mostly nephrotic syndrome types , while fewer chronic nephritis types occur .

4 . Most of the patients with SLE have improved prognosis after treatment and their prognosis is relatively poor .
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.259

【参考文献】