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Clin Rev Allergy Immunol :系统性红斑狼疮与妊娠:一项葡萄牙病例对照研究

2021-10-21 医路坦克 MedSci原创

系统性红斑狼疮(SLE)是一种危及生命的多系统自身免疫性疾病,影响育龄妇女。SLE患者的生育力没有降低,所以狼疮和怀孕之间的联系并不罕见,怀孕前密切跟踪SLE活动是妊娠成功的关键因素。

      系统性红斑狼疮(SLE)是一种危及生命的多系统自身免疫性疾病,影响育龄妇女。SLE患者的生育力没有降低,所以狼疮和怀孕之间的联系并不罕见,发生率在1:660到1:3000的孕妇中。尽管孕产妇和胎儿的结局有所改善,但SLE患者的怀孕仍然与产妇和胎儿的高发病率相关。在这些患者中,流产、死产、早产、胎儿生长受限或妊娠高血压疾病等不良结局的发生率似乎增加。在怀孕期间,红斑狼疮的发病率似乎也在增加,这与孕前疾病的控制密切相关。在受孕时的最佳处理与更好的妊娠结局和减少系统性红斑狼疮的临床症状有关。

      系统性红斑狼疮患者的妊娠处理必须在受孕前开始。怀孕前密切跟踪SLE活动是妊娠成功的关键因素。这与整个妊娠期间的多学科监测以及及时诊断和控制任何狼疮发作相结合,对于减少不良妊娠结局的发生率至关重要。到目前为止,只有少数病例对照研究发表,目的是评估狼疮患者与怀孕相关的风险大小。该研究的目的是评估一组葡萄牙系统性红斑狼疮患者的母婴结局,并与一组健康孕妇进行比较。

     研究对象包括2010至2019年在葡萄牙三级中心接受治疗的所有SLE孕妇。对系统性红斑狼疮患者和一组匹配的健康孕妇的妊娠结局进行了比较。收集母体基线数据,评估母婴和新生儿结局。包括124例系统性红斑狼疮孕妇。受孕期缓解率为95.2%。13.7%的病例在妊娠期被诊断为狼疮发作,17.9%的病例在产后被诊断为狼疮发作。活产率为84.6%,不良结局发生率为40.3%(OR2.64,95%CI 1.67~4.18)。仅考虑受孕时处于缓解期的患者,不良结局的发生率仍显著高于对照组(36.8%vs.20.3%,P<0.01)。流产率15.3%(OR 5.85,95%CI 2.57~13.34),早产率12.4%(OR 1.72,95%CI 0.83~3.57)。SLE患者子痫前期患病率较高(OR 3.92,95%CI 1.32~11.57)。在SLE组,新生儿进入重症监护病房的比率增加(OR 4.99,95%CI 1.47-16.90)。没有新生儿或产妇死亡的报告。

    SLE与APO、流产、先兆子痫、早产、新生儿重症监护入院和剖宫产的风险增加有关,即使在受孕时疾病控制良好的SLE患者中也是如此。因此,SLE患者的妊娠计划应该在受孕前就开始,以实现对所有合并症的最佳控制。此外,妊娠随访必须由训练有素的多学科团队进行,并有具体和严格的监测方案。这必须始终是为SLE患者提供合格产前护理的基础。未来更大规模的队列研究应该集中在系统性红斑狼疮孕妇的产前管理和药物使用上。

文献来源: Braga A,  Barros T,  Faria R, Systemic Lupus Erythematosus and Pregnancy: a Portuguese Case-Control Study.Clin Rev Allergy Immunol 2021 Sep 14

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    2022-07-24 amyloid
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    2021-12-04 xugc
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    2021-11-25 yaanren
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    2021-10-23 膀胱癌
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    2021-10-23 zhouqu_8

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