摘要
目的比较醋酸泼尼松、羟氯喹及其联合血浆置换治疗SLE合并妊娠的临床疗效。方法14例SLE合并妊娠患者中血浆置换组7例患者给予醋酸泼尼松、羟氯喹及血浆置换治疗,非血浆置换组7例患者仅给予醋酸泼尼松和羟氯喹。通过分析14例患者的分娩情况及分娩前疾病活动时及分娩后3、6、12个月的血常规、ESR、尿蛋白水平和SLEDAI评分来评估2组之间的疗效。重复测量数据比较采用两因素重复测量资料的方差分析。结果血浆置换组7例患者均成功分娩,非血浆置换组中有3例患者流产,其余4例均成功分娩。2组成功分娩的11例胎儿出生时Apgar评分均在8分以上且发育良好。2组患者ESR、血小板计数在时间主效应上差异均有统计学意义(F=7.838,P<0.05;F=32.269,P<0.05),血浆置换组分娩后3、6、12个月的ESR低于非血浆置换组,而血小板计数高于非血浆置换组。2组患者的SLEDAI评分在时间主效应上差异无统计学意义(F=2.816,P=0.119),但血浆置换组在分娩后3、6、12个月SLEDAI评分的均值均低于非血浆置换组。血浆置换组中7例患者的尿蛋白水平在分娩后6、12个月全部转阴,而非血浆置换组的7例患者在分娩后3、6、12个月均存在尿蛋白水平阳性的患者。结论血浆置换联合口服醋酸泼尼松、羟氯喹治疗SLE合并妊娠患者比单独口服醋酸泼尼松、羟氯喹更为有效,可减少妊娠丢失并长期改善患者的病情。
Objective To analyze the clinical efficacy of prednisone,hydroxychloroquine(HCQ)combined with plasmapheresis(PE)or not for the treatment of systemic lupus erythematosus(SLE)during pregnancy.Methods Fourteen patients with SLE during pregnancy were analyzed.Totally 7 patients in the non-PE group were given prednisone and HCQ only while 7 patients in PE group were given prednisone and HCQ combined with PE.The fetus outcomes and clinical data,such as erythrocyte sedimentation tate(ESR),urine protein level,blood cell count and systemic lupus erythematosus disease activity index(SLEDAI)score before and after treatment at 3,6,12 months were used to evaluate the efficacy between the two groups.The comparison between groups was performed by repeated measures analysis of varianc(ANOVA).Results Totally 11 patients delivered successfully in both groups while three of the 7 patients in the non-PE group had stillbirth.The 11 fetuses developed well and were born with an Apgar score of 8 or more at birth in both groups.There was a significant difference in ESR and platelet counts between the two groups(F=7.838,P<0.05;F=32.269,P<0.05).The ESR of the PE group was lower than that in the non-PE group at 3,6 and 12 months after delivery,while the platelet count was higher than that in the non-PE group.Although there was no significant difference in the SLEDAI scores between the two groups(F=2.816,P=0.119),the average of SLEDAI scores in the PE group was lower than that in the non-PE group at 3,6 and 12 months after delivery.In addition,the urine protein of 7 patients in the PE group turned negative at 6,12 months after delivery.In the non-PE group,urinary protein-positive patients were present in 3,6,12 months after delivery.Conclusion PE in combination with oral prednisone and HCQ is a more effective than oral prednisone and HCQ alone for patients with active SLE during pregnancy,which reduces pregnancy loss and promote the patient's outcome.
作者
张冰莹
王旭霞
曹建平
王轶奇
安佳
陈俊伟
Zhang Bingying;Wang Xuxia;Cao Jianping;Wang Yiqi;An Jia;Chen Junwei(Department of Rheumatology and Immunology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2020年第6期392-396,共5页
Chinese Journal of Rheumatology
关键词
红斑狼疮
系统性
血浆置换
妊娠结局
Lupus erythematosus
systemic
Plasma exchange
Pregnancy outcome
