Predictors of maternal and fetal complications in SLE patients: a prospective study
Predictors of maternal and fetal complications in SLE patients: a prospective study
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DOI：
10.1007/s12026-014-8572-6
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发表时间：
2014-12-01
影响因子：
4.4
通讯作者：
Doria, Andrea
中科院分区：
文献类型：
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作者：
Borella, Elisabetta;Lojacono, Andrea;Doria, Andrea
该研究的目的是评估系统性红斑狼疮（SLE）患者妊娠期间疾病发作、产科和胎儿并发症的预测因素。对96例SLE患者的132例妊娠进行前瞻性随访，每月进行临床和实验室评估。通过逐步logistic回归分析确定狼疮发作、妊娠期胎儿和产科并发症的预测因素。57%的孕妇会出现狼疮发作，通过孕前狼疮发作的次数可以很好地预测。妊娠前的症状最能预测妊娠期的表现：皮疹引起的皮肤症状，肾炎引起的肾脏症状，血液学异常引起的血液学症状。110例活产，22例胎儿丢失。在活产新生儿中，22%是早产儿。妊娠期高血压最能预测胎儿损失；流产按受孕前一年服用类固醇的量计算；死产是指在受孕前的最后一年里的火焰数量；妊娠前抗磷脂抗体综合征和抗双链DNA抗体水平共存导致早产；妊娠前6个月ECLAM评分高导致胎膜早破，妊娠期高血压导致胎龄小；狼疮抗凝剂阳性子痫前期。我们发现了一些独立的红斑狼疮发作和胎儿及产科并发症的预测因素，这有助于SLE患者妊娠的风险评估。
The aim of the study was to evaluate predictors of disease flares during pregnancy and obstetric and fetal complications in a cohort of systemic lupus erythematosus (SLE) patients. One hundred and thirty-two pregnancies in 96 SLE patients were prospectively followed by monthly clinical and laboratory evaluations. Predictors of lupus flares, fetal and obstetric complications during pregnancy were identified performing stepwise logistic regression analysis. Maternal lupus flares occurred in 57 % of pregnancies and were being best predicted by the number of flares before conception. Manifestations during flares were best predicted by the same features occurred before conception: dermatological flares by skin rash, renal flares by nephritis, and hematological flares by hematological abnormalities. There were 110 live births and 22 fetal losses. Among live newborns, 22 % were premature. Fetal loss was best predicted by hypertension at conception; miscarriages by the amount of steroids taken during the last year before conception; stillbirth by the number of flares during the last year before conception; preterm birth by the coexistence of anti-phospholipid antibody syndrome and anti-double-stranded DNA antibody levels before conception; premature rupture of membranes by high ECLAM score during the 6 months before conception, small for gestation age by hypertension at conception; and preeclampsia by positive lupus anticoagulant. Some independent predictors of lupus flares and fetal and obstetric complications were identified, which can help the risk assessment of pregnancy in SLE patients.