早发性卵巢功能不全患者赠卵IVF获得妊娠在孕期合并系统性红斑狼疮:1例报告并文献复习

发布时间：2019-01-30 21:43

【摘要】：为探讨早发性卵巢功能不全(POI)与免疫因素的关系,对我院生殖中心接诊的1名POI患者通过赠卵成功妊娠后发生系统性红斑狼疮(SLE)的病例进行报告,并结合相关文献,回顾POI病因,讨论SLE与妊娠的相互影响以及POI患者妊娠后合并SLE的临床特点及产科处理,以期为不明原因/免疫因素POI患者孕前处理及妊娠后产科随访提供参考。该病例中,患者确诊卵巢早衰4年,2003年我中心行赠卵IVF成功妊娠。孕11周以颜面部浮肿为首发症状,经免疫学检查、肾脏穿刺活检后确诊为SLE、狼疮性肾炎。综合相关专科意见以及患者意愿,予口服强的松控制狼疮活动,加用阿司匹林、低分子肝素改善胎盘血流,密切监测孕妇各项指标及胎儿生长发育。期间孕妇病情反复,孕晚期出现肝功能损害、胎盘功能下降,B超监测不除外胎儿发育迟缓可能,经全院讨论,择期剖宫产分娩一早产男婴。产后继续专科治疗,随访14年,期间患者复查免疫指标逐渐好转,无狼疮相关表现,考虑SLE临床治愈。其子经新生儿科诊治,其生长发育与同龄人无异。通过病例分析和文献回顾,我们认为免疫因素是POI重要病因,并建议不明原因POI患者孕前完善免疫学检查以保障母胎生命。
[Abstract]:In order to investigate the relationship between (POI) and immune factors in premature ovarian dysfunction, a case of systemic lupus erythematosus (SLE) was reported in a POI patient who was treated in a reproductive center in our hospital. To review the etiology of POI, to discuss the interaction between SLE and pregnancy, the clinical features and obstetric management of POI patients with SLE after pregnancy, in order to provide reference for prepregnancy treatment and postpregnancy obstetric follow-up in patients with POI with unknown cause / immune factor. In this case, ovarian premature failure was diagnosed for 4 years. In 2003, IVF was successfully performed in our center. Facial edema was the first symptom at the 11th week of pregnancy. After immunological examination, SLE, lupus nephritis was diagnosed by renal biopsy. The patients were given oral prednisone to control lupus activity, aspirin and low molecular weight heparin to improve placental blood flow. During the period of pregnant women's repeated condition, liver function damage and placental function decline in the late pregnancy, the fetal growth retardation may not be excluded by B-mode ultrasound monitoring. After the discussion of the whole hospital, selective cesarean section was used to give birth to a preterm male baby. Postpartum treatment was followed up for 14 years. During the follow-up period, the immune indexes were gradually improved and no lupus related manifestations were found. The clinical cure of SLE was considered. His son through the treatment of pediatrics, its growth and development with the same age. Through case analysis and literature review, we believe that immune factors are an important cause of POI, and suggest that POI patients with unknown causes should improve immunological examination before pregnancy in order to protect maternal and fetal life.
【作者单位】：南方医科大学南方医院妇产科生殖医学中心;
【基金】：南方医科大学临床研究重点项目(LC2016ZD010) 国家重点研发计划“生殖健康及重大出生缺陷防控研究”重点专项项目(2017YFC1001100)
【分类号】：R714.8

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