【摘要】：研究目的描述系統(tǒng)性紅斑狼瘡患者的妊娠結(jié)局,探討妊娠不良結(jié)局及妊娠期間疾病復(fù)發(fā)的相關(guān)危險因素,提出系統(tǒng)性紅斑狼瘡患者適宜的懷孕時機,改善妊娠母子結(jié)局。研究對象及方法本文調(diào)查統(tǒng)計在青島大學附屬醫(yī)院產(chǎn)科終止妊娠的SLE患者,時間自2000年1月至2016年8月,161名患者共計162例系統(tǒng)性紅斑狼瘡妊娠結(jié)局進行分析,探討妊娠不良結(jié)局及妊娠期間疾病復(fù)發(fā)的相關(guān)危險因素。采用SPSS18.0軟件進行統(tǒng)計學分析,P0.05表示有統(tǒng)計學意義。研究結(jié)果在161名患者共計162例系統(tǒng)性紅斑狼瘡妊娠結(jié)局中,孕婦一般情況:平均年齡29.38±4.281歲,其中,1.23%(2/162)為病情活動期受孕,11.1%(18/162)為妊娠期初發(fā)SLE,87.65%(142/162)為SLE穩(wěn)定期受孕。妊娠結(jié)局統(tǒng)計:60.5%(98/162)為足月產(chǎn),24.7%(40/162)為早產(chǎn),14.8%(24/162)為妊娠丟失。妊娠丟失結(jié)局中28.57%(4/24)為自然流產(chǎn),28.57%(4/24)為人工流產(chǎn),66.67%(16/24)為死胎。對系統(tǒng)性紅斑狼瘡患者妊娠期間疾病是否復(fù)發(fā)進行統(tǒng)計:51.9%(84/162)為疾病平穩(wěn),48.1%(78/162)為疾病復(fù)發(fā)。在系統(tǒng)性紅斑狼瘡妊娠丟失結(jié)局患者中,統(tǒng)計結(jié)果顯示:系統(tǒng)性紅斑狼瘡患者孕前服藥不規(guī)范、孕前LN病史、孕中補體C3、C4低下表現(xiàn)的陽性率高于妊娠成功組,差異具有統(tǒng)計學意義(P0.05)。妊娠丟失組系統(tǒng)性紅斑狼瘡患者血小板計數(shù)顯著低于早產(chǎn)組血小板計數(shù),顯著低于足月產(chǎn)組血小板計數(shù),差異具有統(tǒng)計學意義(P0.05)。孕前蛋白尿陽性、孕前服藥不規(guī)范、孕中補體C3、C4低下增加SLE患者早產(chǎn)及妊娠丟失風險,差異具有統(tǒng)計學意義(P0.05);孕前激素2片、SSB陽性、妊娠期高血壓SLE患者早產(chǎn)、妊娠丟失風險高于孕前激素〈2片、SSB陰性性、妊娠期血壓正�；颊�,差異具有統(tǒng)計學意義(P0.05);LN病史早產(chǎn)、妊娠丟失風險高于無狼瘡腎炎病史患者,差異具有統(tǒng)計學意義(P0.05)。既往有狼瘡性腎炎病史、妊娠期尿蛋白陽性、藥物服用不規(guī)律SLE患者,妊娠期間疾病活動陽性率顯著高于孕期疾病平穩(wěn)組,差異具有統(tǒng)計學意義(P0.05);妊娠期間疾病活動SLE患者SLE病史年限低于妊娠期間孕期平穩(wěn)組,差異具有統(tǒng)計學意義(P0.05)。研究結(jié)論及意義1、狼瘡腎炎病史、蛋白尿陽性、孕前激素大于2片、孕前服藥不規(guī)范、妊娠期高血壓、補體C3、C4低下、抗SSB陽性,為系統(tǒng)性紅斑狼瘡妊娠患者孕期不良結(jié)局危險因素。2、狼瘡腎炎病史、蛋白尿陽性、孕前服藥不規(guī)范、妊娠期高血壓為系統(tǒng)性紅斑狼瘡患者孕期疾病活動危險因素;3、血小板降低可能與妊娠不良結(jié)局及孕期疾病活動相關(guān),但目前對此仍有爭議,仍需進一步相關(guān)研究。
[Abstract]:Objective to describe the pregnancy outcome of patients with systemic lupus erythematosus (SLE), to explore the adverse outcome of pregnancy and the related risk factors of disease recurrence during pregnancy, and to propose a suitable pregnancy time for SLE patients to improve the maternal-child outcome of pregnancy. Methods the pregnancy outcomes of SLE patients with systemic lupus erythematosus (SLE) in total from January 2000 to August 2016 were investigated and analyzed in the obstetrical department of Qingdao University affiliated Hospital. To investigate the adverse outcome of pregnancy and the risk factors of disease recurrence during pregnancy. SPSS18.0 software was used for statistical analysis, P0.05 was statistically significant. Results among 161 patients with systemic lupus erythematosus (SLE), the average age of pregnant women was 29.38 鹵4.281 years. Among them, 1.23% (2 / 162) of them were pregnant in the active stage of the disease, and the average age of pregnant women was 29.38 鹵4.281 years old. 11.1% (18 / 162) of the patients developed SLE,87.65% in the first trimester of pregnancy (142 / 162) in the stable phase of SLE. The pregnancy outcomes were 60.5% (98 / 162), 24.7% (40 / 162), 14.8% (24 / 162) and 14.8% (24 / 162) respectively. In the outcome of pregnancy loss, 28.57% (4 / 24) were spontaneous abortion, 28.57% (4 / 24) was induced abortion, and 66.67% (16 / 24) was stillbirth. The recurrence rate of systemic lupus erythematosus (SLE) during pregnancy was 51.9% (84 / 162) and 48.1% (78 / 162) respectively. In the patients with pregnancy loss outcome of systemic lupus erythematosus (SLE), the statistical results showed that the positive rate of pre-pregnancy medication, pre-pregnancy LN history, complement C _ 3 and low C _ 4 in pregnancy were higher in SLE patients than those in successful pregnancy group. The difference was statistically significant (P0.05). The platelet count of SLE patients in pregnancy loss group was significantly lower than that in preterm labor group, and significantly lower than that in term delivery group (P0.05). Pre-pregnancy albuminuria was positive, pre-pregnancy medication was not standardized, complement C3, C4 in pregnancy increased the risk of premature delivery and pregnancy loss in SLE patients, the difference was statistically significant (P0.05); Pre-pregnancy hormone 2, SSB positive, pregnancy-induced hypertension SLE patients preterm delivery, pregnancy loss risk is higher than pre-pregnancy hormone < 2 tablets, SSB negative, normal blood pressure during pregnancy, the difference was statistically significant (P0.05); The risk of preterm delivery and pregnancy loss in LN patients was significantly higher than that in patients without lupus nephritis (P0.05). Previous history of lupus nephritis, pregnancy urine protein positive, irregular drug use of SLE patients, the positive rate of disease activity during pregnancy was significantly higher than that of pregnancy disease stable group, the difference was statistically significant (P0.05); The duration of history of SLE in SLE patients with disease activity during pregnancy was significantly lower than that in stable pregnancy group (P0.05). Conclusions and significance 1. History of lupus nephritis, positive proteinuria, preprogestogen greater than 2 tablets, irregular medication before pregnancy, gestational hypertension, complement C3, C4 low, anti-SSB positive, (2) the history of lupus nephritis, positive proteinuria, irregular medication before pregnancy and gestational hypertension were risk factors of disease activity during pregnancy in patients with systemic lupus erythematosus (SLE). (3) Thrombocytopenia may be related to the poor outcome of pregnancy and the activity of disease during pregnancy, but it is still controversial at present, and further related research needs to be done.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R593.241

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