FETAL-OUTCOME IN LUPUS PREGNANCY - A RETROSPECTIVE CASE-CONTROL STUDY OF 242 PREGNANCIES IN 112 PATIENTS
FETAL-OUTCOME IN LUPUS PREGNANCY - A RETROSPECTIVE CASE-CONTROL STUDY OF 242 PREGNANCIES IN 112 PATIENTS
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DOI：
10.1177/096120339300200211
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发表时间：
1993-04-01
期刊：
影响因子：
2.6
通讯作者：
FRIMAN, C
中科院分区：
文献类型：
--
作者：
JULKUNEN, H;JOUHIKAINEN, T;FRIMAN, C
回顾性分析了112例SLE患者242例妊娠的胎儿结局，并与192例年龄、产次和社会经济地位相匹配的对照组417例妊娠的结局进行了比较。SLE诊断后胎儿丢失的相对危险度为2.5（95%可信区间（CI），1.4-4.5），早产的相对危险度为5.8（3.2-10.5），宫内生长迟缓（IUGR）的相对危险度为8.6（3.0-24.3）。已有稳定性狼疮肾炎患者的妊娠结局并不比其他SLE妊娠患者差，本文研究了三种狼疮抗凝（LA）试验和三种抗心磷脂（aCL）酶联免疫吸附试验与胎儿结局的关系。任何LA检测阳性的患者比所有LA检测阴性的患者更常发生既往流产（比值比3.4; 95% CI，1.3-9.0; P = 0.01）。41例患者的抗磷脂抗体（aPL）试验均为阴性，5例（12%）有胎儿丢失史（对照组为16%）。作为一个组，ACL对胎儿丢失的敏感性高于LA（64% vs 50%），但LA更具特异性（77% vs 52%）。一种ACL检测与一种LA检测的组合对于胎儿丢失史具有41-73%的灵敏度和64-73%的特异性。aPL与早产或胎儿生长迟缓无关。总之，SLE胎儿丢失的发生率是正常人群的2.5倍。LA的存在表明胎儿丢失的高风险，而aPL的缺乏表明妊娠结局良好。早产和IUGR在SLE中很常见，但与aPL无关。
Fetal outcome in systemic lupus erythematosus (SLE) was retrospectively analysed in 242 pregnancies in 112 unselected patients, and the outcome was compared with that of 417 pregnancies in 192 control women matched for age, parity and socio-economic status. Relative risk for fetal loss after the diagnosis of SLE was 2.5 (95% confidence interval (CI), 1.4-4.5), for prematurity 5.8 (3.2-10.5) and for intra-uterine growth retardation (IUGR) 8.6 (3.0-24.3). Fetal outcome of pregnancy in patients with pre-existing stable lupus nephritis was no worse than in other SLE pregnancies.Relations of three lupus anticoagulant (LA) assays and three anticardiolipin (aCL) enzyme-linked immunosorbent assays to fetal outcome were studied. Patients positive by any LA assay had a previous fetal loss more often than patients negative by all LA assays (odds ratio 3.4; 95% CI, 1.3-9.0; P = 0.01). Of the 41 patients whose antiphospholipid antibody (aPL) tests were all negative, five (12%) had a history of fetal loss (16% in controls). As a group, aCL was more sensitive for fetal loss than LA (64% vs 50%), but LA was more specific (77% vs 52%). Combinations of one aCL assay with one LA assay had a 41-73% sensitivity and a 64-73% specificity for a history of fetal loss. aPL did not correlate to prematurity or fetal growth retardation.In conclusion, fetal loss in SLE is 2.5 times more prevalent than in the normal population. The presence of LA indicates a high risk for fetal loss, and the absence of aPL is an indication of a favorable pregnancy outcome. Prematurity and IUGR are common in SLE, but they are not associated with aPL.