系统性红斑狼疮合并妊娠子代早产儿42例临床分析

全美盈; 王丹华

doi:10.7499/j.issn.1008-8830.2013.12.002

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中国当代儿科杂志 ›› 2013, Vol. 15 ›› Issue (12) : 1045-1049. DOI: 10.7499/j.issn.1008-8830.2013.12.002

新生儿疾病专题

系统性红斑狼疮合并妊娠子代早产儿42例临床分析

全美盈, 王丹华

作者信息 +

Clinical features of preterm infants born to mothers with systemic lupus erythematosus：a retrospective analysis

QUAN Mei-Ying, WANG Dan-Hua

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摘要

目的探讨系统性红斑狼疮（SLE）合并妊娠子代早产儿的临床特点，提高新生儿科医师对这部分早产儿的认识。方法收集2000年1月至2012年6月间SLE合并妊娠子代早产儿的临床资料进行回顾性分析，并与同期出生的除SLE合并妊娠子代早产儿以外的2 308例早产儿住院期间并发症发生情况进行对比。结果 SLE合并妊娠子代早产儿共42例，女婴比例明显高于男婴，其中确诊新生儿狼疮综合征4例。新生儿感染为SLE合并妊娠子代早产儿最常见并发症（47.62%），其次为小于胎龄儿（28.57%），新生儿呼吸窘迫综合征（26.19%），新生儿窒息和先天性心脏病（均为14.29%），肺出血（4.76%）；与同期收治的2 308例早产儿合并新生儿感染（16.81%）、小于胎龄儿（13.21%）和先天性心脏病（5.16%）的发生率进行比较，差异均有统计学意义（均P<0.05）；其他合并症的发生率在两组早产儿间比较差异均无统计学意义。结论 SLE合并妊娠子代早产儿易合并感染性疾病、小于胎龄儿及先天性心脏病，而呼吸方面并发症与同期其他早产儿相比无显著差异。

Abstract

Objective To retrospectively characterize clinical features of preterm infants born to mothers with systemic lupus erythematosus (SLE). Methods Clinical data of preterm infants born to mothers with SLE in Peking Union Medical College Hospital over a period of more than 10 years (2000-2012) and preterm babies born to mothers without SLE in the same hospital and during the same time period were collected. Preterm-associated complications in the two groups of babies were comparatively analyzed. Results During the time period studied, 128 women with SLE delivered a total of 134 babies, 86 at full-term and 42 at preterm. Of the 42 preterm infants, 4 were diagnosed with neonatal lupus syndrome. Neonatal infection was the most common complication in preterm infants born to SLE mothers, which occurred in 20 cases (47.62%), followed by small for gestational age (28.57%), neonatal respiratory distress syndrome (26.19%), congenital heart disease (14.29%), and neonatal pulmonary hemorrhage (4.76%). In the same time period, 2 308 preterm babies were born to mothers without SLE. In these preemies, 16.81% experienced neonatal infection, 13.21% were small for gestational age, and 5.16% had congenital heart disease. All these parameters were significantly lower than in preterm babies born to mothers with SLE (P<0.05). Conclusions SLE preterm offspring seem to be more prone to neonatal infection, small for gestational age and at a higher risk of congenital heart disease as compared to preterm babies from women without SLE.

导出引用

全美盈, 王丹华. 系统性红斑狼疮合并妊娠子代早产儿42例临床分析[J]. 中国当代儿科杂志. 2013, 15(12): 1045-1049 https://doi.org/10.7499/j.issn.1008-8830.2013.12.002

QUAN Mei-Ying, WANG Dan-Hua. Clinical features of preterm infants born to mothers with systemic lupus erythematosus：a retrospective analysis[J]. Chinese Journal of Contemporary Pediatrics. 2013, 15(12): 1045-1049 https://doi.org/10.7499/j.issn.1008-8830.2013.12.002

参考文献

[1] 尹玉竹, 周水生, 黄建林, 吴玲玲, 佘芹. 系统性红斑狼疮合并妊娠患者孕期病情的变化及其对母儿结局的影响[J].中华风湿病学杂, 2012, 16(8): 53-56.
[2] Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis[J]. Clin J Am Soc Nephrol, 2010, 5(11): 2060-2068.
[3] Liu J, Zhao Y, Song Y, Zhang W, Bian X, Yang J, et al. Pregnancy in women with systemic lupus erythematosus: a retrospective study of 111 pregnancies in Chinese women[J]. J Matern Fetal Neonatal Med, 2012, 25(3): 261-266.
[4] 温艳芳, 李懿莎, 罗卉, 左晓霞, 周亚欧. 系统性红斑狼疮患者合并妊娠的临床研究[J].中华风湿病学杂志, 2010, 14(8): 543-545.
[5] Ambrosio P, Lermann R, Cordeiro A, Borges A, Nogueira I, Serrano F. Lupus and pregnancy-15 years of experience in a tertiary center[J]. Clin Rev Allergy Immunol, 2010, 38(2-3): 77-81.
[6] Wong CH, Chen TL, Lee CS, Lin CJ, Chen CP. Outcome of pregnancy in patients with systemic lupus erythematosus[J]. Taiwan J Obstet Gynecol, 2006, 45(2): 120-123.
[7] 宋亦军, 刘冬舟, 刘俊涛, 赵岩. 妊娠合并系统性红斑狼疮94例临床分析[J].中华内科杂志, 2008, 47(12): 1008-1011.
[8] Mokbel A, Geilan AM, AboElgheit S. Could women with systemic lupus erythematosus (SLE) have successful pregnancy outcomes? Prospective observational study[J]. Egypt Rheumatol, 2013, 35: 133-139.
[9] Hoehberg MC．Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus[J]. Arthritis Rheum, 1997, 40(9):1725．
[10] Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI: a disease activity index for lupus patients. The Committee on Prognosis Studies in SLE[J]. Arthritis Rheum, 1992, 35(6): 630-640．
[11] 邵肖梅, 叶鸿瑁, 邱小汕. 实用新生儿学(第4版)[M]. 北京: 人民卫生出版社, 2011: 46-578.
[12] Aggarwal R, Sestak AL, Chakravarty EF, Harley JB, Scofield RH. Excess female siblings and male fetal loss in families with systemic lupus erythematosus[J]. J Rheumatol, 2013, 40(4): 430-434.
[13] Aggarwal N, Raveendran A, Suri V, Chopra S, Sikka P, Sharma A. Pregnancy outcome in systemic lupus erythematosus: Asia's largest single centre study[J]. Arch Gynecol Obstet, 2011, 284(2): 281-285.
[14] 刘冬舟, 赵岩, 宋亦军, 谭艳红, 洪小平, 孙保东. 系统性红斑狼疮合并妊娠145例次母婴结局及临床预测因素[J]. 中华风湿病学杂志, 2009, 13(12): 824-828.
[15] Chakravarty EF, Colon I, Langen ES, Nix DA, El-Sayed YY, Genovese MC, et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus[J]. Am J Obstet Gynecol, 2005, 192(6): 1897-1904.
[16] Iams JD, Romero R, Culhane JF, Goldenberg RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth[J]. Lancet, 2008, 371(9607): 164-175.
[17] Tincani A, Danieli E, Nuzzo M, Scarsil M, Motta M, Cimaz R, et al. Impact of in utero environment on the offspring of lupus patients[J]. Lupus, 2006, 15(11): 801-807.
[18] Clark CA, Spitzer KA, Nadler JN, Laskin CA. Preterm deliveries in women with systemic lupus erythematosus[J]. J Rheumatol, 2003, 30(10): 2127-2132.
[19] Clark CA, Spitzer KA, Laskin CA. Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40-year period[J]. J Rheumatol, 2005, 32(9): 1709-1712.
[20] 刘海元, 杨剑秋, 刘俊涛, 高劲松, 边旭明. 妊娠合并系统性红斑狼疮早产36例分析[J]. 中国医刊, 2008, 43(6): 57-59.
[21] Marodi L. Innate cellular immune responses in newborns[J]. Clin Immunol, 2006, 118(2-3): 137-144.
[22] Guilmot A, Hermann E, Braud VM, Carlier Y, Truyens C. Natural killer cell responses to infections in early life[J]. J Innate Immun, 2011, 3(3): 280-288.
[23] Marodi L. Neonatal innate immunity to infectious agents[J]. Infect Immun, 2006, 74(4): 1999-2006.
[24] Lee LA. Transient autoimmunity related to maternal autoantibodies: neonatal lupus[J]. Autoimmun Rev, 2005, 4(4): 207-213．
[25] Johnson MJ, Petri M, Witter FR, Repke JT. Evaluation of preterm delivery in a systemic lupus erythematosus pregnancy[J]. Clinic Obstet Gynecol, 1995, 86(3): 396-399.
[26] Al Arfaj AS, Khalil N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia[J]. Lupus, 2010, 19(14): 1665-1673.
[27] Surita FG, Parpinelli MA, Yonehara E, Krupa F, Cecatti JG. Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings[J]. Sao Paulo Med J, 2007, 125(2): 91-95.