两种评估孕期系统性红斑狼疮活动方法的比较

发布时间：2018-11-15 09:37

【摘要】：目的:通过对32例妊娠合并系统性红斑狼疮进行回顾性分析,探讨孕期系统性红斑狼疮活动的诊断、妊娠并发症及妊娠结局。方法:对大连医科大学附属第一医院产科2004年1月-2014年12月收治的32例妊娠合并系统性红斑的患者的临床资料进行回顾性分析。分别以临床医师经验和LAI-P(lupus active index pregnancy)方法对32例患者进行分组并进行分析。结果:1.一般情况:平均年龄为30.88±0.64岁(25-39岁),平均孕次为2次(1-5次),平均产次为1次(0-3次),系统性红斑狼疮病史为(0.01-18)年,足月分娩为20例,早产3例,流产9例。2.临床医师经验法与LAI-P法的比较分别以临床医师经验法和LAI-P法对32例病例进行分组评估,临床医师经验法:狼疮活动为14例;狼疮未活动的为18例,LAI-P法:32例中狼疮活动的为22例;狼疮未活动的为10例。两种评估方法间比较差异有统计学意义(P=0.0080.05),两种评分方法的吻合系数κ=0.552,吻合度一般,以临床医师经验为标准:LAI-P的敏感度为100%(95%CI 76.8-100.0%),特异度为55.6%(95%CI 30.8-78.5%),准确性为75%,阳性预测值为0.636,阴性预测值为1,阳性似然比为2.25(95%CI 1.5-3.4),阴性似然比为0。3.妊娠并发症的比较:3.1流产及子痫前期的发生率比较,统计学分析显示,差异无显著意义(P0/05)。3.2 LAI-P评估为SLE活动而临床医师经验评估为SLE未活动的病例为8例,其中发生流产、子痫前期及双下肢静脉血栓并发症的分别为1例。4.临床医师经验法与LAI-P法临床指标的比较在泼尼松0.5mg/Kg·d、血小板20×109/L蛋白尿3g/24h(得分较高)三个分级指标中临床医师经验法和LAI-P法中SLE活动组和未活动组无差异;而在泼尼松或羟氯喹"f0.5mg/Kg·d、血小板20×109/L、蛋白尿3g/24h(得分较低即早期变化时)三个分级临床指标中,LAI-P法活动组临床指标发生改变的病例数明显高于临床医师经验法;LAI-P法未活动组中临床指标发生改变发生的例数明显低于临床医师经验法。统计学分析显示,差异无统计学意义。5.LAI-P法活动组中足月分娩的为10例,早产3例,流产9例,分娩时或分娩后应用激素加量或冲击治疗10例;未活动组中足月分娩的为10例,无早产及流产病例,仅有3例在分娩时或分娩后应用激素加量或冲击治疗。结论:1.妊娠合并系统性红斑狼疮孕期可应用LAI-P评估疾病是否活动,且LAI-P法较临床医师经验法更敏感、更合理。2.LAI-P法能早期预测孕期系统性红斑狼疮活动,且在系统性红斑狼疮活动时妊娠并发症的发生率较高,妊娠结局较差,因此建议孕期系统性红斑狼疮活动的早诊断、早治疗3.药物剂量、血小板、尿蛋白等临床观察指标的改变提示孕期系统性红斑狼疮活动。
[Abstract]:Objective: to investigate the diagnosis, complications and outcome of systemic lupus erythematosus (SLE) in 32 cases of pregnancy with systemic lupus erythematosus (SLE). Methods: the clinical data of 32 cases of pregnancy complicated with systemic erythema in the first affiliated Hospital of Dalian Medical University from January 2004 to December 2014 were retrospectively analyzed. 32 patients were divided and analyzed by clinical experience and LAI-P (lupus active index pregnancy) method. The result is 1: 1. General conditions: the average age was 30.88 卤0.64 years (25-39 years), the average pregnancy was 2 (1-5), the average birth was 1 (0-3), the history of systemic lupus erythematosus was (0.01-18) years. There were 20 cases of term delivery, 3 cases of premature delivery and 9 cases of abortion. The clinical physician experience method and LAI-P method were used to evaluate 32 cases by clinical experience method and LAI-P method respectively. The clinical experience method: 14 cases of lupus activity; 18 cases were inactive in lupus, 22 cases were active lupus in 32 cases by LAI-P method, 10 cases were inactive in lupus. There was significant difference between the two evaluation methods (P0. 0080.05). The coincident coefficient 魏 = 0. 552, the degree of agreement was normal, and the difference between the two evaluation methods was significant (P < 0. 0080.05). The sensitivity, specificity, accuracy and positive predictive value of LAI-P were 100% (95%CI 76.8-100.0%), 55.6% (95%CI 30.8-78.5%), 7575% and 0.636%, respectively. The negative predictive value was 1, the positive likelihood ratio was 2.25 (95%CI 1.5-3.4), and the negative likelihood ratio was 0.3. Comparison of pregnancy complications: 3.1 the incidence of abortion and preeclampsia, statistical analysis showed, There was no significant difference (P0 / 05). There were 8 cases with SLE activity assessed by LAI-P and SLE inactive by clinician's experience. The complications of abortion, preeclampsia and lower extremity venous thrombosis were 1 case. The comparison of clinicians' experience method with that of LAI-P method was performed in prednisone 0.5mg/Kg d. There was no difference between active group and inactive group in the three grading indexes of platelet 20 脳 10 9 / L proteinuria 3g/24h (high score): the clinician's experience method and LAI-P 's method. In prednisone or hydroxychloroquine "f0.5mg/Kg d, platelet 20 脳 109 / L, proteinuria 3g/24h (low score is early change), The number of patients with changes in clinical indexes in LAI-P group was significantly higher than that in clinicians' experience. The number of patients in the inactive group with LAI-P was significantly lower than that in the clinician's experience. There were 10 cases of term delivery, 3 cases of premature delivery, 9 cases of abortion, and 10 cases of hormone addition or shock therapy during and after delivery in 5.LAI-P group. In the inactive group, there were 10 cases of term delivery, no cases of premature delivery and miscarriage. Only 3 cases were treated with hormone addition or shock therapy during and after delivery. Conclusion: 1. In pregnancy with systemic lupus erythematosus, LAI-P can be used to assess the activity of the disease, and LAI-P is more sensitive and reasonable than the experience of clinical doctors. 2.LAI-P can predict the activity of systemic lupus erythematosus in early pregnancy. The incidence of pregnancy complications is higher and the pregnancy outcome is poor when systemic lupus erythematosus is active. Therefore, early diagnosis and treatment of systemic lupus erythematosus activity during pregnancy are recommended. Changes in drug dose, platelet, urine protein and other clinical indicators suggest systemic lupus erythematosus activity during pregnancy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R714.259

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