本文選題：系統(tǒng)性紅斑狼瘡 + 妊娠�。� 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討我院近10年來(lái)住院診治的40例孕期初發(fā)SLE患者的發(fā)病年齡、病程、首發(fā)癥狀、系統(tǒng)受累等臨床特征，實(shí)驗(yàn)室檢查結(jié)果及疾病的治療與轉(zhuǎn)歸，以期能為該病的臨床診療提供一定的參考。 方法：對(duì)2004年1月至2013年9月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院住院診治的40例孕期初發(fā)系統(tǒng)性紅斑狼瘡患者的臨床資料進(jìn)行回顧性分析。按年齡匹配隨機(jī)抽取60例同期住院診治的非孕期初發(fā)SLE患者的臨床資料作為對(duì)照組，該組患者需滿(mǎn)足近12個(gè)月來(lái)無(wú)妊娠史。將40例孕期初發(fā)SLE患者按有無(wú)腎臟受累情況分為A組（腎臟受累患者）和B組（無(wú)腎臟受累患者）兩個(gè)亞組。記錄其發(fā)病年齡（首次出現(xiàn)癥狀的年齡）、病程（第一次出現(xiàn)癥狀到來(lái)就診的時(shí)間）、發(fā)病所處的妊娠階段（詳見(jiàn)附表3）、孕周（第一次出現(xiàn)癥狀時(shí)的妊娠周數(shù)）、產(chǎn)婦類(lèi)型（初產(chǎn)婦或經(jīng)產(chǎn)婦）、首發(fā)癥狀、系統(tǒng)受累及實(shí)驗(yàn)室檢查結(jié)果、腎穿刺活檢結(jié)果、妊娠結(jié)局及疾病治療與轉(zhuǎn)歸。觀察組和對(duì)照組進(jìn)行組間比較，觀察組兩亞組分別進(jìn)行組內(nèi)比較。采用SPSS16.0軟件處理數(shù)據(jù)，正態(tài)分布計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差描述，t檢驗(yàn)分析；非正態(tài)分布、方差不齊的數(shù)據(jù)使用中位數(shù)、四分位數(shù)間距描述，Mann-Whitney U檢驗(yàn)。計(jì)數(shù)資料采用百分率描述，χ2檢驗(yàn)分析。所有結(jié)果均以P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1.近10年來(lái)，在我院住院診治的SLE合并妊娠患者共132例，其中40例患者在妊娠期或產(chǎn)褥期首次診斷了SLE，所占比例達(dá)30.1%。40例孕期初發(fā)SLE患者的發(fā)病年齡平均為（26.4±4.2）歲。絕大多數(shù)患者（占85%）的發(fā)病出現(xiàn)在妊娠的早期和中期。40例患者的妊娠結(jié)局不容樂(lè)觀，其中高達(dá)27.5%的患者出現(xiàn)胎兒質(zhì)量異常，包括宮內(nèi)死胎6例、胎兒畸形2例、難免流產(chǎn)2例，自然流產(chǎn)1例；而選擇人工終止妊娠的比例則高達(dá)47.5%。 2.孕期初發(fā)SLE患者的病程長(zhǎng)短不一，但均在6個(gè)月以?xún)?nèi)，最短為3天，較同期住院診治的非孕期初發(fā)SLE患者短。 3.所有患者的首發(fā)癥狀均以皮膚紅斑、關(guān)節(jié)炎和/或關(guān)節(jié)痛多見(jiàn)。觀察組患者則更容易出現(xiàn)面部和/或雙下肢水腫。 4.兩組患者的系統(tǒng)受累個(gè)數(shù)、SLEDAI評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義，即孕期初發(fā)SLE患者與非孕期初發(fā)患者狼瘡病情活動(dòng)度基本相近。但是，孕期初發(fā)SLE患者往往更容易出現(xiàn)腎臟損害，，而出現(xiàn)全身癥狀如乏力、發(fā)熱等及關(guān)節(jié)肌肉病變則相對(duì)要少。 5.觀察組患者白細(xì)胞計(jì)數(shù)總體水平高于對(duì)照組，而血紅蛋白、血清白蛋白水平及免疫球蛋白三項(xiàng)IgG、IgA、IgM水平則總體低于對(duì)照組。兩組患者血清補(bǔ)體、血沉及C-反應(yīng)蛋白差異無(wú)統(tǒng)計(jì)學(xué)意義。 6.高達(dá)55%的觀察組患者出現(xiàn)腎臟損害，所占比例明顯高于對(duì)照組。兩組患者尿常規(guī)檢查中反映腎臟病變活動(dòng)的指標(biāo)差異無(wú)統(tǒng)計(jì)學(xué)意義，但是觀察組患者的24小時(shí)尿蛋白定量高于對(duì)照組，且更容易出現(xiàn)24小時(shí)尿蛋白定量大于0.5g。因此，孕期初發(fā)SLE患者當(dāng)腎臟受累時(shí)，臨床類(lèi)型易出現(xiàn)腎病綜合征型，而較少出現(xiàn)慢性腎炎型。 7.觀察組組內(nèi)兩個(gè)亞組中，A組系統(tǒng)受累個(gè)數(shù)增多，狼瘡病情活動(dòng)度更高，更容易出現(xiàn)嚴(yán)重貧血，血沉加快也更明顯，補(bǔ)體C3下降更嚴(yán)重。 8.無(wú)論是觀察組與對(duì)照組的比較，還是觀察組兩個(gè)亞組之間的比較，自身抗體陽(yáng)性率、抗ds-DNA抗體滴度，差異均無(wú)統(tǒng)計(jì)學(xué)意義。 9.經(jīng)治療后，盡管高達(dá)81.8%的觀察組患者病情可好轉(zhuǎn)，但是觀察組患者總的好轉(zhuǎn)率仍然低于對(duì)照組，提示觀察組患者預(yù)后較差。 結(jié)論： 1.孕期初發(fā)SLE患者傾向于在妊娠的早期和中期發(fā)病。 2.不良妊娠結(jié)局在孕期初發(fā)SLE患者身上發(fā)生率高。 3.妊娠期初發(fā)的SLE更容易累及腎臟；當(dāng)腎臟受累時(shí)，患者臨床表現(xiàn)以腎病綜合征型多見(jiàn)，而較少出現(xiàn)慢性腎炎型。 4.大多數(shù)孕期初發(fā)SLE患者經(jīng)治療后病情可好轉(zhuǎn)，其預(yù)后相對(duì)較差。
[Abstract]:Objective : To explore the clinical characteristics of 40 cases of SLE who were hospitalized in the past 10 years in our hospital , including the age , the course , the symptoms of the first episode , the system ' s involvement and so on . The results of the laboratory examination and the treatment and prognosis of the disease were discussed in order to provide some reference for the clinical diagnosis and treatment of the disease .

Methods : The clinical data of 40 patients with SLE who were hospitalized in the first Affiliated Hospital of Guangxi Medical University from January 2004 to September 2013 were analyzed retrospectively .
The data of non - normal distribution and variance was described by median , quartile range description , Mann - Whitney U test . The count data was described by percentage , 蠂2 test analysis . All results were statistically significant at P & lt ; 0.05 .

Results :

1 . In recent 10 years , 132 cases of SLE complicated with pregnancy were diagnosed and treated in our hospital . Among them , 40 patients were diagnosed with SLE at the first time during pregnancy or during the perium perium period . The average age of the 40 patients ( 85 % ) was ( 26 . 4 鹵 4.2 ) years . Most of the 40 patients ( 85 % ) had abnormal fetal quality , including 6 cases of intrauterine fetal death , 2 cases of fetal malformation , 2 cases of inevitable abortion and 1 case of spontaneous abortion .
The proportion of artificial termination of pregnancy was up to 47.5 % .

2 . The duration of the onset of SLE in the first trimester of pregnancy was short , but within 6 months , the shortest was 3 days , and the patients with SLE who were hospitalized for the same period were shorter than those who were hospitalized in the same period .

3 . The initial symptoms of all patients were observed with erythema , arthritis and / or arthralgia in the skin . Patients in the observation group were more likely to develop facial and / or bilateral lower extremity edema .

4 . There was no significant difference in SLEDAI score between the two groups , that is , the activity of SLE patients with SLE was similar to that of non - pregnant first - onset SLE patients . However , the patients with SLE tended to be more prone to kidney damage , while systemic symptoms such as hypodynamia , fever , and joint muscle diseases were relatively few .

5 . The overall level of white blood cell count in the observation group was higher than that in the control group , while the levels of hemoglobin , serum albumin and immunoglobulin IgG , IgA and IgM were lower than those in the control group . There was no significant difference in serum complement , ESR and C - reactive protein in the two groups .

6 . There was no significant difference in the indexes of renal lesion in the observation group with up to 55 % , but the 24 - hour urinary protein in the observation group was higher than that of the control group , and the 24 - hour urinary protein was more likely to be more than 0.5g . Therefore , when the kidney was tired , the clinical type was easy to develop nephrotic syndrome type , and the chronic nephritis type was less .

7 . In the two subgroups in the group , the number of patients in group A was increased , the activity of lupus was higher , severe anemia was more likely to occur , the ESR was faster , and the C3 of complement C3 was more severe .

8 . Whether the comparison between the observation group and the control group , or the comparison between the two subgroups in the observation group , the positive rate of the autoantibodies and the anti - ds - DNA antibody titer were not statistically significant .

9 . After treatment , the overall improvement rate in the observation group was still lower than that of the control group , although the improvement rate was 81.8 % in the observation group , and the prognosis was poor in the observation group .

Conclusion :

1 . At the beginning of pregnancy , SLE patients tend to be in the early and middle stages of pregnancy .

2 . The incidence of adverse pregnancy outcome was high in SLE patients during pregnancy .

3 . SLE is more likely to involve the kidney during pregnancy .
When the kidneys are involved , the clinical manifestations of the patients are mostly nephrotic syndrome types , while fewer chronic nephritis types occur .

4 . Most of the patients with SLE have improved prognosis after treatment and their prognosis is relatively poor .
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R714.259

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