狼疮肾炎病史对女性患者妊娠及其胎儿结局的影响

翻译者：梁娜娜 校对者：杨艳丽 审核者：张莉芸

Impactofprevious lupus nephritisonmaternalandfetaloutcomesduring pregnancy

Previousreportssuggestthatrenalinvolvementbefore pregnancy oractiverenaldiseaseduring pregnancy maybeassociatedwithpoorfetalandmaternaloutcomesinsystemic lupus erythematosus(SLE)women.Wereportourexperienceoffetalandmaternalcomplicationsinpregnant lupus womenwithandwithoutprevious lupus nephritis.WeanalyzedtheclinicalrecordsofpregnantSLEpatientsattendedinatertiaryreferencecenterduringa5-yearperiod.Patientswereallocatedintotwogroupsaccordingtothepresenceorabsenceofprevious lupus nephritis.Womenwereevaluatedmonthlyduring pregnancy andatleast1monthpostpartum.Maternalandfetaloutcomesof pregnancy wereabstracted.Weincluded95pregnanciesin92patients.Comparedwithpregnantwomenwithout lupus nephritis(n=60),pregnancieswithprevious lupus nephritis(n=35)wereassociatedwithahigherriskofmaternalcomplications(88.5%vs.43.3%,p=0.00001),higherrateof lupus flares(54.2%vs.25%,p=0.004),andrenalflares(45.7%vs.6.6%,p=0.00001),butmostofwhichinmostinstanceswerereversible.Ontheotherhand,fetal outcome wassimilarinbothgroups.Multivariateanalysisshowedthatprevious lupus nephritisandactive lupus atconceptionwerepredictorsofadversematernal outcome.Pregnanciesinwomenwithprevious lupus nephritishadahigherrateofmaternalcomplicationsincomparisonwiththosewithout.However,fetal prognosis wassimilarinbothgroups.

曾有报道显示，系统性红斑狼疮患者(SLE)，在孕前有肾脏受累或怀孕期间肾脏病情活动与其自身及胎儿的不良结局有着相关性。我们对既往无论有无狼疮肾炎的狼疮孕妇及胎儿的并发症进行了追踪报道。其中包括对SLE孕妇长达五年的临床记录进行了系统分析，期间这些患者均要求在指定的第三中心进行随访。根据既往有无狼疮性肾炎病史，我们把患者分成了2组，对其在怀孕期间及产后至少1个月内每月进行病情评估。该研究纳入实验组95例和对照组92例。与既往无狼疮肾炎病史的孕妇组相比(n=60)，有狼疮肾炎病史的孕妇组(n=35)其出现并发症的机率较高(88.5%vs.43.3%,p=0.00001)，而且还有较高的狼疮耀斑率(54.2%vs.25%,p=0.004)和肾耀斑(45.7%vs.6.6%,p=0.00001)，但大多数情况下，大部分并发症是可逆的。另一方面，两组患者其胎儿结局类似。多因素分析结果表明，与既往无狼疮肾炎病史的孕妇组相比，怀孕前有肾脏系统受累或怀孕期间肾脏病情活动的SLE孕妇结局往往不好，其出现并发症的机率较高，但两组患者其胎儿预后表现相似。

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