High-risk factors for adverse pregnancy outcomes in systemic lupus erythaematosus: a retrospective study of a Chinese population.
High-risk factors for adverse pregnancy outcomes in systemic lupus erythaematosus: a retrospective study of a Chinese population.
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系统性红斑狼疮不良妊娠结局的高危因素：中国人群的回顾性研究
DOI：
10.1136/bmjopen-2021-049807
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发表时间：
2021-11-16
期刊：
影响因子：
2.9
通讯作者：
Di W
中科院分区：
文献类型：
--
作者：
Jiang M;Chang Y;Wang Y;Fu Q;Lin S;Wu J;Di W
目的探讨系统性红斑狼疮（SLE）妊娠不良结局的高危因素。设计一项回顾性病历审查研究。数据收集于2010年11月至2018年12月在中国上海的一家三级医疗中心。对513例妊娠合并SLE患者的临床资料进行回顾性分析。27例因个人原因进行人工流产的患者被排除。主要结局指标APO是主要结局，包括胎儿丢失、早产、小于胎龄儿（SGA）、窒息性窒息、复合胎儿APO和妊娠期高血压疾病（HDP）。采用多因素Logistic回归和斯皮尔曼相关分析确定SLE患者APO的危险因素。结果妊娠期高血压、低补体C3血症、抗心磷脂抗体IgM阳性及妊娠期疾病发作是导致胎儿丢失的危险因素。早产的危险因素包括疾病发作、使用免疫抑制剂和HDP。双胎妊娠、疾病发作和高血压是SGA的危险因素，孕前高血压是窒息的独立危险因素。复合胎儿APO的独立危险因素包括双胎妊娠、孕前高血压、妊娠期疾病发作、HDP、低补体血症-C3和使用免疫抑制剂。SLE合并HDP的危险因素包括孕前高血压、肾脏疾病和血小板减少。相反，阿司匹林的使用是防止胎儿丢失和早产的保护因素。ds-DNA值对APO的诊断价值较低，而补体减少的程度可预测复合胎儿APO和胎儿丢失的发生率。妊娠前20周发生的蛋白尿可能导致APO。结论本研究确定了每种载脂蛋白O的危险因素。从常规指标中筛选出更有预测意义的指标，有助于临床医生更准确地预测SLE患者的妊娠结局，降低APO的发生率。
Objective To clarify high-risk factors for adverse pregnancy outcomes (APOs) in systemic lupus erythaematosus (SLE). Design A retrospective chart review study. Setting Data were collected in a tertiary medical centre, Shanghai, China, from November 2010 to December 2018. Participants A total of 513 pregnancies with SLE were retrospectively analysed. Twenty-seven patients who underwent artificial abortions due to personal reasons were excluded. Primary outcome measures APOs were primary outcomes, including foetal loss, premature birth, small for gestational age (SGA), asphyxia neonatorum, composite foetal APOs and hypertensive disorders of pregnancy (HDP). Multivariable logistic regression and Spearman correlation analysis were performed to determine the risk factors for APOs in SLE. Results Risk factors for foetal loss included prepregnancy hypertension, hypocomplementaemia-C3, anticardiolipin antibodies-IgM positivity and disease flares during pregnancy. Risk factors for premature birth included disease flares, use of immunosuppressive agents and HDP. Moreover, twin pregnancy, disease flares and HDP were risk factors for SGA, and prepregnancy hypertension was an independent risk factor for asphyxia neonatorum. Independent risk factors for composite foetal APOs included twin pregnancy, prepregnancy hypertension, disease flares during pregnancy, HDP, hypocomplementaemia-C3 and the use of immunosuppressive agents. Risk factors for SLE complicated with HDP included prepregnancy hypertension, renal disorders and thrombocytopaenia. Conversely, the use of aspirin was a protective factor against foetal loss and premature birth. The ds-DNA value had a low diagnostic value for APOs, whereas the extent of complement reduction may predict the incidence of composite foetal APOs and foetal loss. Proteinuria occurring in the first 20 gestational weeks may lead to APOs. Conclusion Established risk factors for each APO were identified in this study. Indicators with more predictive significance have been screened out from conventional indicators, which may help clinicians predict the pregnancy outcome of patients with SLE more accurately and minimise the incidence of APOs.
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