系统性红斑狼疮妊娠结局分析
发布时间：2019-04-22 18:45
【摘要】：研究目的描述系统性红斑狼疮患者的妊娠结局,探讨妊娠不良结局及妊娠期间疾病复发的相关危险因素,提出系统性红斑狼疮患者适宜的怀孕时机,改善妊娠母子结局。研究对象及方法本文调查统计在青岛大学附属医院产科终止妊娠的SLE患者,时间自2000年1月至2016年8月,161名患者共计162例系统性红斑狼疮妊娠结局进行分析,探讨妊娠不良结局及妊娠期间疾病复发的相关危险因素。采用SPSS18.0软件进行统计学分析,P0.05表示有统计学意义。研究结果在161名患者共计162例系统性红斑狼疮妊娠结局中,孕妇一般情况:平均年龄29.38±4.281岁,其中,1.23%(2/162)为病情活动期受孕,11.1%(18/162)为妊娠期初发SLE,87.65%(142/162)为SLE稳定期受孕。妊娠结局统计:60.5%(98/162)为足月产,24.7%(40/162)为早产,14.8%(24/162)为妊娠丢失。妊娠丢失结局中28.57%(4/24)为自然流产,28.57%(4/24)为人工流产,66.67%(16/24)为死胎。对系统性红斑狼疮患者妊娠期间疾病是否复发进行统计:51.9%(84/162)为疾病平稳,48.1%(78/162)为疾病复发。在系统性红斑狼疮妊娠丢失结局患者中,统计结果显示:系统性红斑狼疮患者孕前服药不规范、孕前LN病史、孕中补体C3、C4低下表现的阳性率高于妊娠成功组,差异具有统计学意义(P0.05)。妊娠丢失组系统性红斑狼疮患者血小板计数显著低于早产组血小板计数,显著低于足月产组血小板计数,差异具有统计学意义(P0.05)。孕前蛋白尿阳性、孕前服药不规范、孕中补体C3、C4低下增加SLE患者早产及妊娠丢失风险,差异具有统计学意义(P0.05);孕前激素2片、SSB阳性、妊娠期高血压SLE患者早产、妊娠丢失风险高于孕前激素〈2片、SSB阴性性、妊娠期血压正常患者,差异具有统计学意义(P0.05);LN病史早产、妊娠丢失风险高于无狼疮肾炎病史患者,差异具有统计学意义(P0.05)。既往有狼疮性肾炎病史、妊娠期尿蛋白阳性、药物服用不规律SLE患者,妊娠期间疾病活动阳性率显著高于孕期疾病平稳组,差异具有统计学意义(P0.05);妊娠期间疾病活动SLE患者SLE病史年限低于妊娠期间孕期平稳组,差异具有统计学意义(P0.05)。研究结论及意义1、狼疮肾炎病史、蛋白尿阳性、孕前激素大于2片、孕前服药不规范、妊娠期高血压、补体C3、C4低下、抗SSB阳性,为系统性红斑狼疮妊娠患者孕期不良结局危险因素。2、狼疮肾炎病史、蛋白尿阳性、孕前服药不规范、妊娠期高血压为系统性红斑狼疮患者孕期疾病活动危险因素;3、血小板降低可能与妊娠不良结局及孕期疾病活动相关,但目前对此仍有争议,仍需进一步相关研究。
[Abstract]:Objective to describe the pregnancy outcome of patients with systemic lupus erythematosus (SLE), to explore the adverse outcome of pregnancy and the related risk factors of disease recurrence during pregnancy, and to propose a suitable pregnancy time for SLE patients to improve the maternal-child outcome of pregnancy. Methods the pregnancy outcomes of SLE patients with systemic lupus erythematosus (SLE) in total from January 2000 to August 2016 were investigated and analyzed in the obstetrical department of Qingdao University affiliated Hospital. To investigate the adverse outcome of pregnancy and the risk factors of disease recurrence during pregnancy. SPSS18.0 software was used for statistical analysis, P0.05 was statistically significant. Results among 161 patients with systemic lupus erythematosus (SLE), the average age of pregnant women was 29.38 卤4.281 years. Among them, 1.23% (2 / 162) of them were pregnant in the active stage of the disease, and the average age of pregnant women was 29.38 卤4.281 years old. 11.1% (18 / 162) of the patients developed SLE,87.65% in the first trimester of pregnancy (142 / 162) in the stable phase of SLE. The pregnancy outcomes were 60.5% (98 / 162), 24.7% (40 / 162), 14.8% (24 / 162) and 14.8% (24 / 162) respectively. In the outcome of pregnancy loss, 28.57% (4 / 24) were spontaneous abortion, 28.57% (4 / 24) was induced abortion, and 66.67% (16 / 24) was stillbirth. The recurrence rate of systemic lupus erythematosus (SLE) during pregnancy was 51.9% (84 / 162) and 48.1% (78 / 162) respectively. In the patients with pregnancy loss outcome of systemic lupus erythematosus (SLE), the statistical results showed that the positive rate of pre-pregnancy medication, pre-pregnancy LN history, complement C _ 3 and low C _ 4 in pregnancy were higher in SLE patients than those in successful pregnancy group. The difference was statistically significant (P0.05). The platelet count of SLE patients in pregnancy loss group was significantly lower than that in preterm labor group, and significantly lower than that in term delivery group (P0.05). Pre-pregnancy albuminuria was positive, pre-pregnancy medication was not standardized, complement C3, C4 in pregnancy increased the risk of premature delivery and pregnancy loss in SLE patients, the difference was statistically significant (P0.05); Pre-pregnancy hormone 2, SSB positive, pregnancy-induced hypertension SLE patients preterm delivery, pregnancy loss risk is higher than pre-pregnancy hormone < 2 tablets, SSB negative, normal blood pressure during pregnancy, the difference was statistically significant (P0.05); The risk of preterm delivery and pregnancy loss in LN patients was significantly higher than that in patients without lupus nephritis (P0.05). Previous history of lupus nephritis, pregnancy urine protein positive, irregular drug use of SLE patients, the positive rate of disease activity during pregnancy was significantly higher than that of pregnancy disease stable group, the difference was statistically significant (P0.05); The duration of history of SLE in SLE patients with disease activity during pregnancy was significantly lower than that in stable pregnancy group (P0.05). Conclusions and significance 1. History of lupus nephritis, positive proteinuria, preprogestogen greater than 2 tablets, irregular medication before pregnancy, gestational hypertension, complement C3, C4 low, anti-SSB positive, (2) the history of lupus nephritis, positive proteinuria, irregular medication before pregnancy and gestational hypertension were risk factors of disease activity during pregnancy in patients with systemic lupus erythematosus (SLE). (3) Thrombocytopenia may be related to the poor outcome of pregnancy and the activity of disease during pregnancy, but it is still controversial at present, and further related research needs to be done.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.241
本文编号：2463101
[Abstract]:Objective to describe the pregnancy outcome of patients with systemic lupus erythematosus (SLE), to explore the adverse outcome of pregnancy and the related risk factors of disease recurrence during pregnancy, and to propose a suitable pregnancy time for SLE patients to improve the maternal-child outcome of pregnancy. Methods the pregnancy outcomes of SLE patients with systemic lupus erythematosus (SLE) in total from January 2000 to August 2016 were investigated and analyzed in the obstetrical department of Qingdao University affiliated Hospital. To investigate the adverse outcome of pregnancy and the risk factors of disease recurrence during pregnancy. SPSS18.0 software was used for statistical analysis, P0.05 was statistically significant. Results among 161 patients with systemic lupus erythematosus (SLE), the average age of pregnant women was 29.38 卤4.281 years. Among them, 1.23% (2 / 162) of them were pregnant in the active stage of the disease, and the average age of pregnant women was 29.38 卤4.281 years old. 11.1% (18 / 162) of the patients developed SLE,87.65% in the first trimester of pregnancy (142 / 162) in the stable phase of SLE. The pregnancy outcomes were 60.5% (98 / 162), 24.7% (40 / 162), 14.8% (24 / 162) and 14.8% (24 / 162) respectively. In the outcome of pregnancy loss, 28.57% (4 / 24) were spontaneous abortion, 28.57% (4 / 24) was induced abortion, and 66.67% (16 / 24) was stillbirth. The recurrence rate of systemic lupus erythematosus (SLE) during pregnancy was 51.9% (84 / 162) and 48.1% (78 / 162) respectively. In the patients with pregnancy loss outcome of systemic lupus erythematosus (SLE), the statistical results showed that the positive rate of pre-pregnancy medication, pre-pregnancy LN history, complement C _ 3 and low C _ 4 in pregnancy were higher in SLE patients than those in successful pregnancy group. The difference was statistically significant (P0.05). The platelet count of SLE patients in pregnancy loss group was significantly lower than that in preterm labor group, and significantly lower than that in term delivery group (P0.05). Pre-pregnancy albuminuria was positive, pre-pregnancy medication was not standardized, complement C3, C4 in pregnancy increased the risk of premature delivery and pregnancy loss in SLE patients, the difference was statistically significant (P0.05); Pre-pregnancy hormone 2, SSB positive, pregnancy-induced hypertension SLE patients preterm delivery, pregnancy loss risk is higher than pre-pregnancy hormone < 2 tablets, SSB negative, normal blood pressure during pregnancy, the difference was statistically significant (P0.05); The risk of preterm delivery and pregnancy loss in LN patients was significantly higher than that in patients without lupus nephritis (P0.05). Previous history of lupus nephritis, pregnancy urine protein positive, irregular drug use of SLE patients, the positive rate of disease activity during pregnancy was significantly higher than that of pregnancy disease stable group, the difference was statistically significant (P0.05); The duration of history of SLE in SLE patients with disease activity during pregnancy was significantly lower than that in stable pregnancy group (P0.05). Conclusions and significance 1. History of lupus nephritis, positive proteinuria, preprogestogen greater than 2 tablets, irregular medication before pregnancy, gestational hypertension, complement C3, C4 low, anti-SSB positive, (2) the history of lupus nephritis, positive proteinuria, irregular medication before pregnancy and gestational hypertension were risk factors of disease activity during pregnancy in patients with systemic lupus erythematosus (SLE). (3) Thrombocytopenia may be related to the poor outcome of pregnancy and the activity of disease during pregnancy, but it is still controversial at present, and further related research needs to be done.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.241
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