66位系统性红斑狼疮患者的妊娠转归

发布时间：2018-06-12 03:36

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

【摘要】：研究目的:探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者妊娠后母婴结局及不良妊娠结局的危险因素。研究对象及方法:采用回顾性分析方法,针对2005年10月至2015年09月在南方医科大学南方医院终止妊娠的患者资料进行统计分析,比较疾病缓解-轻度活动组(SLEDAI≤9分)和中-重度活动组(SLEDAI9分)胎儿结局、母婴并发症,分析不良妊娠结局危险因素。采用SPSS 19.0统计学软件进行统计分析,以P0.05为差异有统计学意义。研究结果:66位SLE患者共妊娠69次,确诊SLE平均年龄为22.9±5.1岁,妊娠时SLE平均病程为4.1±3.6年,妊娠期间SLEDAI最高评分平均为6.8±7.4分,妊娠过程中45例(65.2%)接受药物治疗,44例(63.8%)应用糖皮质激素,19例(27.5%)应用羟氯喹。除去2例非计划生育及1例母亲尖锐湿疣选择人工流产外,余胎儿丢失共24例(34.8%),治疗性流产18例(26.1%),死胎3例(4.3%),自然流产2例(2.9%),母婴死亡1例(1.4%)。69次妊娠共分娩新生儿42例(60.9%),平均出生体质量2640.5±672.0 g,早产15例(21.7%),低出生体质量儿15例(21.7%),IUGR 6例(8.7%)。同病情缓解-轻度活动组相比,中-重度活动组胎儿丢失[12(54.5%)vs 12(25.5%)]明显升高,足月产[4(18.2%)vs 23(48.9%)]、新生儿出生体质量[(2073.0±778.7)g vs(2817.8±533.7)g]明显降低(P0.05)。妊娠期间新发SLE15例(21.7%),高血压15例(21.7%),活动性狼疮肾炎26例(37.7%),糖尿病7例(10.1%),肺部感染7例(10.1%),子痫前期或子痫7例(10.1%),肾功能不全10例(14.5%),HELLP综合征1例(1.4%),孕妇死亡1例(1.4%)。中-重度活动组SLE新发[9(40.9%)vs 6(12.8%)]、高血压[12(54.5%)vs 3(6.4%)]、活动性狼疮肾炎[22(100%)vs 4(8.5%)]、肺部感染[5(22.7%)vs 2(4.3%)]、肾功能不全[8(36.4%)vs 2(4.3%)]多于病情缓解-轻度活动组(P0.05)。单因素Logistic回归分析发现高血压(OR值 13.00,95%CI:1.60～105.93)、活动性狼疮肾炎(OR值 9.68,95%CI:2.52～37.18)、血小板减少症(OR值4.00,95%CI:1.02～15.60)为不良妊娠结局的危险因素,多因素Logistic回归分析发现活动性狼疮肾炎(OR值6.10,95%CI:1.43～25.96)为不良妊娠结局的独立危险因素,差异有统计学意义(P0.05)。15位妊娠新发SLE的患者中,均孕早期(53.3%)及孕中期(46.7%)发病,且该类患者疾病活动度高,以肾脏、血液系统受累为主,胎儿丢失[11(73.3%)vs 13(24.1%)]、高血压[8(53.3%)vs 7(13.0%)]、活动性狼疮肾炎[9(60.0%)vs 17(31.5%)]、肾功能不全[5(33.3%)vs 5(9.3%)]发生率高于非妊娠新发SLE妊娠患者。研究结论:大部分SLE妊娠患者仍然能够成功分娩,但SLE患者孕期狼疮中-重度活动增加胎儿丢失、母亲并发症的发生,活动性狼疮肾炎是不良妊娠结局的独立危险因素,且妊娠期新发SLE患者的母婴结局更差。狼疮患者妊娠转归仍有待进一步提高,妊娠期间应定期监测患者SLE各项指标,合理用药,控制狼疮活动,以获得良好的妊娠结局。
[Abstract]:Objective: To explore the risk factors of maternal and infant outcome and bad pregnancy outcome in patients with systemic lupus erythematosus (SLE) after pregnancy. Research objects and methods: a retrospective analysis was used to analyze the data of the termination of pregnancy in the Southern Hospital of Southern Medical University from October 2005 to 09 months in 2015. To compare the fetal outcomes of the mild activity group (SLEDAI < 9) and the moderate and severe activity group (SLEDAI9), the maternal and child complications and the risk factors of bad pregnancy outcome. The statistical analysis was carried out by the SPSS 19 statistics software, and the difference between them was statistically significant. The result of the study was that 66 patients with SLE were pregnant with 69 times, and the average age of SLE was confirmed. The average course of SLE was 4.1 + 3.6 years in pregnancy. The average SLEDAI score was 6.8 + 7.4 during pregnancy. 45 cases (65.2%) received medication during pregnancy, 44 (63.8%) applied glucocorticoid and 19 (27.5%) applied hydroxychloroquine. 24 cases (34.8%), 18 cases of therapeutic abortion (26.1%), 3 cases of stillbirth (4.3%), 2 cases of spontaneous abortion (2.9%), 1 cases of maternal and infant death (1.4%).69 pregnancy, 42 (60.9%), average birth weight 2640.5 + G, premature birth cases, low birth weight cases, and mild activity group, compared with the mild activity group. The loss of [12 (54.5%) vs 12 (25.5%) in the severe activity group was significantly higher, [4 (18.2%) vs 23 (48.9%) was produced in the full-term, the birth body mass [(2073 + 778.7) g vs (2817.8 + 533.7) g] decreased significantly (P0.05). The new SLE15 cases (21.7%), high blood pressure 15 (21.7%), active lupus nephritis, diabetes mellitus, lung sensation during pregnancy 7 cases (10.1%), 7 cases of preeclampsia or eclampsia (10.1%), 10 cases of renal insufficiency (14.5%), 1 cases of HELLP syndrome (1.4%), 1 pregnant women (1.4%). SLE new [9 (40.9%) vs 6 (12.8%) in the medium and severe activity group, [22 (VS) of active lupus nephritis, vs [9 of pulmonary infection, and [8 renal function. 6.4%) vs 2 (4.3%)] more than disease remission - mild activity group (P0.05). Single factor Logistic regression analysis found that hypertension (OR 13.00,95%CI:1.60 to 105.93), active lupus nephritis (OR value 9.68,95%CI:2.52 to 37.18), thrombocytopenia (OR 4.00,95%CI:1.02 to 15.60) as a risk factor for bad pregnancy outcome, multiple factor Logistic regression It was found that active lupus nephritis (OR value 6.10,95%CI:1.43 ~ 25.96) was an independent risk factor for undesirable pregnancy outcome. The difference was statistically significant (P0.05) in the patients with new SLE in.15 pregnancy, both in the early pregnancy (53.3%) and in the middle of the pregnancy (46.7%), and the disease activity was high in this type of patients, mainly with kidney, blood system involvement and fetal loss of [1. 1 (73.3%) vs 13 (24.1%)], hypertension [8 (53.3%) vs 7 (13%)], active lupus nephritis [9 (60%) vs 17 (31.5%)], renal insufficiency [5 (33.3%) vs 5 (9.3%)) incidence higher than non pregnancy new SLE pregnancy patients. Conclusions: most of the SLE pregnancy patients can still be successful, but SLE patients with moderate severe activity in pregnancy increase fetal loss, The occurrence of maternal complications, active lupus nephritis is an independent risk factor for adverse pregnancy outcomes, and the maternal and infant outcome of the new SLE patients in pregnancy is worse. The outcome of the pregnancy in the patients with lupus remains to be further improved. During pregnancy, the patients' SLE indicators should be monitored regularly, the rational use of drugs, and the control of lupus activities in order to obtain a good pregnancy outcome.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.25

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