摘要
目的:探讨系统性红斑狼疮(systematic lupus erythematosus,SLE)不良妊娠结局(adverse pregnancy outcomes,APOs)的预测因素。方法:回顾性分析2016年5月至2021年9月于北京大学人民医院产科住院分娩的SLE患者318例,根据患者是否存在APOs分为APOs组85例和非APOs组233例,分析SLE患者的病程、临床表现、实验室指标和疾病活动度(systematic lupus erythematosus disease activity index 2000,SLEDAI-2000)对妊娠结局的影响。结果:(1)SLE的平均发病年龄为(24.65±5.26)岁。在318次妊娠中,娩出302个活产婴儿(302/318,94.97%),16例(16/318,5.03%)死胎,无新生儿死亡;活产婴儿中有足月儿206例(206/302,68.21%),小于胎龄儿(small for gestational age infant,SGA)65例(65/302,21.52%),早产儿31例(31/302,10.26%)。(2)APOs组SLEDAI-2000评分显著高于非APOs组(5.82±4.97 vs.3.74±3.72,t=4.019,P=0.001)。(3)APOs组糖皮质激素用量高于非APOs组[12.50(7.50,50.00)mg vs.10.00(5.00,15.00)mg,P<0.001]。(4)单因素分析显示,狼疮性肾炎(31.76%vs.21.03%,χ^(2)=3.946,P=0.047)、血小板减少(24.71%vs.9.01%,χ^(2)=13.380,P<0.001)、低补体血症(36.47%vs.26.03%,χ^(2)=4.847,P=0.028)、抗磷脂抗体阳性(20.00%vs.11.16%,χ^(2)=4.163,P=0.041)和妊娠期未接受治疗(21.18%vs.11.59%,χ^(2)=4.713,P=0.030)与SLE患者发生APOs相关。在多因素分析中,低补体血症(OR=1.935,95%CI:1.104~3.393,P=0.021)、血小板减少(OR=2.671,95%CI:1.309~5.449,P=0.007)及抗磷脂抗体阳性(OR=2.153,95%CI:1.054~4.399,P=0.035)是SLE患者发生不良妊娠结局的独立危险因素。结论:血小板减少、低补体血症及抗磷脂抗体阳性可以预测SLE患者APOs的发生,对指导SLE患者计划妊娠具有重要意义。
Objective:To identify predictors of adverse pregnancy outcomes(APOs)in patients with systemic lupus erythematosus(SLE).Methods:A retrospective analysis was conducted on 318 SLE patients who delivered at Peking University People’s Hospital from May 2016 to September 2021.These patients were categorized into two groups:The APOs group(n=85)and the non-APOs group(n=233).Various factors,including disease duration,clinical manifestations,laboratory parameters,and systemic lupus erythematosus disease activity index 2000(SLEDAI-2000)scores,were analyzed for their association with APOs.SPSS 26.0 software was used to analyze the data.Results:The mean age of SLE patients in this study was(24.65±5.26)years.Among the 318 pregnancies studied,302(302/318,94.97%)resulted in live births,while 16(16/318,5.03%)cases ended in stillbirths,with no neonatal deaths reported.Among the live births,206(206/302,68.21%)were full-term infants,65(65/302,21.52%)cases were small for gestational age(SGA),and 31(31/302,10.26%)cases were preterm.The SLEDAI-2000 scores were significantly higher in the APOs group compared with the non-APOs group(5.82±4.97 vs.3.74±3.72,t=4.019,P=0.001),suggesting greater disease activity as a risk factor.Similarly,glucocorticoid doses were markedly higher in the APOs group[12.50(7.50,50.00)mg vs.10.00(5.00,15.00)mg,P<0.001],underscoring the link between disease severity and APOs.Univariate analysis revealed that lupus nephritis(31.76%vs.21.03%,χ^(2)=3.946,P=0.047),thrombocytopenia(24.71%vs.9.01%,χ^(2)=13.380,P<0.001),hypocomplementemia(36.47%vs.26.03%,χ^(2)=4.847,P=0.028),antiphospholipid antibody positivity(20.00%vs.11.16%,χ^(2)=4.163,P=0.041),and absence of pregnancy treatment(21.18%vs.11.59%,χ^(2)=4.713,P=0.030)were associated with increased APOs risk.Multivariate Logistic regression identified thrombocytopenia(OR=2.671,95%CI:1.309-5.449,P=0.007),hypocomplementemia(OR=1.935,95%CI:1.104-3.393,P=0.021),and antiphospholipid antibody positivity(OR=2.153,95%CI:1.054-4.399,P=0.035)as independent predictors of APOs.Conclusion:These findings highlight that certain clinical and laboratory features,including thrombocytopenia,hypocomplementemia,and antiphospholipid antibody positivity,are critical independent predictors of APOs in SLE patients.The study underscores the importance of close monitoring and proactive management of these risk factors to improve pregnancy outcomes in SLE patients.
作者
王文琼
侯玉珂
李春
张学武
WANG Wenqiong;HOU Yuke;LI Chun;ZHANG Xuewu(Department of Rheumatology and Immunology,Peking University People’s Hospital,Beijing 100044,China)
出处
《北京大学学报(医学版)》
北大核心
2025年第3期599-603,共5页
Journal of Peking University:Health Sciences
基金
中华国际医学交流基金会基金(Z-2018-40-2101)。
关键词
系统性红斑狼疮
不良妊娠结局
预测因素
Systemic Lupus Erythematosus
Adverse pregnancy outcomes
Predictors
