Steroid hormones and disease activity during pregnancy in systemic lupus erythematosus
Steroid hormones and disease activity during pregnancy in systemic lupus erythematosus
复制标题
DOI：
10.1002/art.10248
复制
发表时间：
2002-04-15
期刊：
影响因子：
--
通讯作者：
Gambari, PF
中科院分区：
文献类型：
--
作者：
Doria, A;Cutolo, M;Gambari, PF
目标。目的：分析系统性红斑狼疮(SLE)患者孕期激素水平的变化。此外，在妊娠期，类固醇浓度与系统性红斑狼疮活动是否有关系。对17例连续妊娠的系统性红斑狼疮患者和8例配对的健康孕妇进行前瞻性研究。疾病活动性由欧洲共识狼疮活动性测量(ECLAM)评分评估。测定下列激素：睾酮、17β-雌二醇(雌二醇)、皮质醇、脱氢表雄酮硫酸盐(DHEAS)和孕酮。疾病活动评分在孕期和产后差异有统计学意义(P<；0.05)，孕晚期降低，中期和产后升高。无论是患者还是健康受试者，在孕期和产后期间，血清中所有类固醇的水平都有显著变化。在SLE患者中，雌二醇、孕酮和DHEAS的浓度与对照组相比显著降低。血清雌二醇和孕酮水平与对照组不同。除了皮质醇外，每天服用5 mg泼尼松的患者之间的类固醇水平没有差异，皮质醇在后一组中如预期的那样较低。SLE患者在怀孕期间观察到的主要激素变化是在怀孕中期和-甚至更晚-妊娠期间，雌激素水平意外缺乏血清水平的增加，以及较小程度的孕酮血清水平的上升。这种增加的缺乏可能是由于胎盘的妥协。因此，这些类固醇激素的变化可能会导致体液免疫反应活性降低，这可能与雌激素/雄激素平衡的变化有关，这反过来可能是妊娠晚期SLE患者疾病活动减少的原因。
Objectives. To analyze the variation of steroid hormone levels during pregnancy in patients with systemic lupus erythematosus (SLE). Moreover, to investigate whether, during gestation, there is any relationship between steroid concentration and SLE activity.Methods. Seventeen consecutive pregnant SLE patients and 8 matched healthy pregnant controls were studied prospectively. Disease activity was evaluated by European Consensus Lupus Activity Measure (ECLAM) score modified for pregnancy. The following hormones were evaluated: testosterone, 17beta-estradiol (estradiol), cortisol, dehydroepiandrosterone sulfate (DHEAS), and progesterone.Results. Disease activity score significantly varied during pregnancy and postpartum (P < 0.05), being decreased in the third trimester and increased in the second trimester and postpartum. Serum levels of all steroids varied significantly during pregnancy and the postpartum period both in patients and in healthy subjects. In SLE patients, estradiol, progesterone, and DHEAS concentrations were found to be significantly reduced compared with controls. Serum level profiles of estradiol and progesterone were different from those observed in controls. No differences in the steroid levels were observed between patients taking prednisone 5 mg/day, apart from cortisol, which was, as expected, lower in the latter group.Conclusions. The major hormonal alteration observed during pregnancy in SLE patients was an unexpected lack of estrogen serum level increase, and, to a lesser extent, progesterone serum level increase, during the second and-even more-the third trimester of gestation. This lack of increase probably was due to placental compromise. Therefore, these steroid hormone variations may result in a lower humoral immune response activation, probably related to a change in the estrogen/androgen balance, that in turn could account for the decrease in disease activity observed during the third trimester in pregnant SLE patients.