Placental pathology in systemic lupus erythematosus: A prospective study
Placental pathology in systemic lupus erythematosus: A prospective study
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DOI：
10.1016/s0002-9378(98)70277-7
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发表时间：
1998-07-01
影响因子：
9.8
通讯作者：
Lockshin, MD
中科院分区：
文献类型：
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作者：
Magid, MS;Kaplan, C;Lockshin, MD
目的：系统性红斑狼疮和抗磷脂抗体常在系统性红斑狼疮患者中发现，与不良妊娠结局相关。本研究区分了这些因素对妊娠结局和系统性红斑狼疮孕妇胎盘病理状况的影响。研究设计：对33例系统性红斑狼疮患者的37例妊娠和40例胎盘进行前瞻性研究。结果：单发系统性红斑狼疮，而非系统性红斑狼疮活动性，与自然流产、早产和胎儿生长受限增加有关。胎盘相关因素有缺血-缺氧改变、蜕膜血管病变、蜕膜及胎儿血栓、慢性绒毛炎和胎盘重量下降。广泛梗死和胎儿死亡是抗磷脂抗体相关的重要发现。结论：个体血管病变/凝血功能障碍似乎介导了与抗磷脂抗体相关的和许多系统性红斑狼疮相关的对胎盘和妊娠结局的有害影响。抗磷脂抗体的存在在很大程度上预示着胎儿的死亡，但并非总是如此。不依赖抗磷脂抗体的慢性绒毛炎可能是系统性红斑狼疮相关改变的第二种机制。
OBJECTIVES: Systemic lupus erythematosus and antiphospholipid antibody, often identified in patients with systemic lupus erythematosus, are associated with poor pregnancy outcome. This study distinguishes between the effect of each of these factors on gestational outcome and placental pathologic conditions in pregnant patients with systemic lupus erythematosus.STUDY DESIGN: Thirty-seven pregnancies and 40 placentas from 33 women with systemic lupus erythematosus were studied prospectively.RESULTS: Systemic lupus erythematosus alone, but not systemic lupus erythematosus activity, was associated with increased spontaneous abortions, preterm gestations, and fetal growth restriction. Placental correlates were ischemic-hypoxic change, decidual vasculopathy, decidual and fetal thrombi, chronic villitis, and decreased placental weight. Extensive infarction and fetal death were important antiphospholipid antibody-related findings.CONCLUSIONS: Decidual vasculopathy/coagulopathy appears to mediate the antiphospholipid antibody-related and much of the systemic lupus erythematosus-related deleterious effect on the placenta and gestational outcome. The presence of antiphospholipid antibody largely, but not invariably, predicts fetal death. Antiphospholipid antibody-independent chronic villitis may represent a second mechanism of systemic lupus erythematosus-related change.