本文選題：系統(tǒng)性紅斑狼瘡 + 妊娠��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究目的:探討系統(tǒng)性紅斑狼瘡(systemic lupus erythematosus,SLE)患者妊娠后母嬰結(jié)局及不良妊娠結(jié)局的危險因素。研究對象及方法:采用回顧性分析方法,針對2005年10月至2015年09月在南方醫(yī)科大學(xué)南方醫(yī)院終止妊娠的患者資料進行統(tǒng)計分析,比較疾病緩解-輕度活動組(SLEDAI≤9分)和中-重度活動組(SLEDAI9分)胎兒結(jié)局、母嬰并發(fā)癥,分析不良妊娠結(jié)局危險因素。采用SPSS 19.0統(tǒng)計學(xué)軟件進行統(tǒng)計分析,以P0.05為差異有統(tǒng)計學(xué)意義。研究結(jié)果:66位SLE患者共妊娠69次,確診SLE平均年齡為22.9±5.1歲,妊娠時SLE平均病程為4.1±3.6年,妊娠期間SLEDAI最高評分平均為6.8±7.4分,妊娠過程中45例(65.2%)接受藥物治療,44例(63.8%)應(yīng)用糖皮質(zhì)激素,19例(27.5%)應(yīng)用羥氯喹。除去2例非計劃生育及1例母親尖銳濕疣選擇人工流產(chǎn)外,余胎兒丟失共24例(34.8%),治療性流產(chǎn)18例(26.1%),死胎3例(4.3%),自然流產(chǎn)2例(2.9%),母嬰死亡1例(1.4%)。69次妊娠共分娩新生兒42例(60.9%),平均出生體質(zhì)量2640.5±672.0 g,早產(chǎn)15例(21.7%),低出生體質(zhì)量兒15例(21.7%),IUGR 6例(8.7%)。同病情緩解-輕度活動組相比,中-重度活動組胎兒丟失[12(54.5%)vs 12(25.5%)]明顯升高,足月產(chǎn)[4(18.2%)vs 23(48.9%)]、新生兒出生體質(zhì)量[(2073.0±778.7)g vs(2817.8±533.7)g]明顯降低(P0.05)。妊娠期間新發(fā)SLE15例(21.7%),高血壓15例(21.7%),活動性狼瘡腎炎26例(37.7%),糖尿病7例(10.1%),肺部感染7例(10.1%),子癇前期或子癇7例(10.1%),腎功能不全10例(14.5%),HELLP綜合征1例(1.4%),孕婦死亡1例(1.4%)。中-重度活動組SLE新發(fā)[9(40.9%)vs 6(12.8%)]、高血壓[12(54.5%)vs 3(6.4%)]、活動性狼瘡腎炎[22(100%)vs 4(8.5%)]、肺部感染[5(22.7%)vs 2(4.3%)]、腎功能不全[8(36.4%)vs 2(4.3%)]多于病情緩解-輕度活動組(P0.05)。單因素Logistic回歸分析發(fā)現(xiàn)高血壓(OR值 13.00,95%CI:1.60～105.93)、活動性狼瘡腎炎(OR值 9.68,95%CI:2.52～37.18)、血小板減少癥(OR值4.00,95%CI:1.02～15.60)為不良妊娠結(jié)局的危險因素,多因素Logistic回歸分析發(fā)現(xiàn)活動性狼瘡腎炎(OR值6.10,95%CI:1.43～25.96)為不良妊娠結(jié)局的獨立危險因素,差異有統(tǒng)計學(xué)意義(P0.05)。15位妊娠新發(fā)SLE的患者中,均孕早期(53.3%)及孕中期(46.7%)發(fā)病,且該類患者疾病活動度高,以腎臟、血液系統(tǒng)受累為主,胎兒丟失[11(73.3%)vs 13(24.1%)]、高血壓[8(53.3%)vs 7(13.0%)]、活動性狼瘡腎炎[9(60.0%)vs 17(31.5%)]、腎功能不全[5(33.3%)vs 5(9.3%)]發(fā)生率高于非妊娠新發(fā)SLE妊娠患者。研究結(jié)論:大部分SLE妊娠患者仍然能夠成功分娩,但SLE患者孕期狼瘡中-重度活動增加胎兒丟失、母親并發(fā)癥的發(fā)生,活動性狼瘡腎炎是不良妊娠結(jié)局的獨立危險因素,且妊娠期新發(fā)SLE患者的母嬰結(jié)局更差。狼瘡患者妊娠轉(zhuǎn)歸仍有待進一步提高,妊娠期間應(yīng)定期監(jiān)測患者SLE各項指標(biāo),合理用藥,控制狼瘡活動,以獲得良好的妊娠結(jié)局。
[Abstract]:Objective: To explore the risk factors of maternal and infant outcome and bad pregnancy outcome in patients with systemic lupus erythematosus (SLE) after pregnancy. Research objects and methods: a retrospective analysis was used to analyze the data of the termination of pregnancy in the Southern Hospital of Southern Medical University from October 2005 to 09 months in 2015. To compare the fetal outcomes of the mild activity group (SLEDAI < 9) and the moderate and severe activity group (SLEDAI9), the maternal and child complications and the risk factors of bad pregnancy outcome. The statistical analysis was carried out by the SPSS 19 statistics software, and the difference between them was statistically significant. The result of the study was that 66 patients with SLE were pregnant with 69 times, and the average age of SLE was confirmed. The average course of SLE was 4.1 + 3.6 years in pregnancy. The average SLEDAI score was 6.8 + 7.4 during pregnancy. 45 cases (65.2%) received medication during pregnancy, 44 (63.8%) applied glucocorticoid and 19 (27.5%) applied hydroxychloroquine. 24 cases (34.8%), 18 cases of therapeutic abortion (26.1%), 3 cases of stillbirth (4.3%), 2 cases of spontaneous abortion (2.9%), 1 cases of maternal and infant death (1.4%).69 pregnancy, 42 (60.9%), average birth weight 2640.5 + G, premature birth cases, low birth weight cases, and mild activity group, compared with the mild activity group. The loss of [12 (54.5%) vs 12 (25.5%) in the severe activity group was significantly higher, [4 (18.2%) vs 23 (48.9%) was produced in the full-term, the birth body mass [(2073 + 778.7) g vs (2817.8 + 533.7) g] decreased significantly (P0.05). The new SLE15 cases (21.7%), high blood pressure 15 (21.7%), active lupus nephritis, diabetes mellitus, lung sensation during pregnancy 7 cases (10.1%), 7 cases of preeclampsia or eclampsia (10.1%), 10 cases of renal insufficiency (14.5%), 1 cases of HELLP syndrome (1.4%), 1 pregnant women (1.4%). SLE new [9 (40.9%) vs 6 (12.8%) in the medium and severe activity group, [22 (VS) of active lupus nephritis, vs [9 of pulmonary infection, and [8 renal function. 6.4%) vs 2 (4.3%)] more than disease remission - mild activity group (P0.05). Single factor Logistic regression analysis found that hypertension (OR 13.00,95%CI:1.60 to 105.93), active lupus nephritis (OR value 9.68,95%CI:2.52 to 37.18), thrombocytopenia (OR 4.00,95%CI:1.02 to 15.60) as a risk factor for bad pregnancy outcome, multiple factor Logistic regression It was found that active lupus nephritis (OR value 6.10,95%CI:1.43 ~ 25.96) was an independent risk factor for undesirable pregnancy outcome. The difference was statistically significant (P0.05) in the patients with new SLE in.15 pregnancy, both in the early pregnancy (53.3%) and in the middle of the pregnancy (46.7%), and the disease activity was high in this type of patients, mainly with kidney, blood system involvement and fetal loss of [1. 1 (73.3%) vs 13 (24.1%)], hypertension [8 (53.3%) vs 7 (13%)], active lupus nephritis [9 (60%) vs 17 (31.5%)], renal insufficiency [5 (33.3%) vs 5 (9.3%)) incidence higher than non pregnancy new SLE pregnancy patients. Conclusions: most of the SLE pregnancy patients can still be successful, but SLE patients with moderate severe activity in pregnancy increase fetal loss, The occurrence of maternal complications, active lupus nephritis is an independent risk factor for adverse pregnancy outcomes, and the maternal and infant outcome of the new SLE patients in pregnancy is worse. The outcome of the pregnancy in the patients with lupus remains to be further improved. During pregnancy, the patients' SLE indicators should be monitored regularly, the rational use of drugs, and the control of lupus activities in order to obtain a good pregnancy outcome.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.25

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本文編號：2008141