系统性红斑狼疮妊娠

Melissa Fernandes, V. Bernardino, A. Taulaigo, Jorge Fernandes, A. Lladó, F. Serrano
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引用次数: 1

摘要

系统性红斑狼疮(SLE)是一种病因不明的自身免疫性疾病,通常影响育龄妇女。SLE孕妇被认为是高危患者,其妊娠结局因高母婴死亡率和发病率而复杂化。产科发病率包括早产、胎儿生长受限(FGR)和新生儿狼疮综合征。妊娠期活动性SLE是不良妊娠结局的一个强有力的预测因子,妊娠期疾病恶化可能更频繁地发生。因此,产妇SLE的管理应包括预防策略,以尽量减少疾病活动和减少不良妊娠结局。在怀孕期间患有活动性疾病的患者有更高的发作风险,如狼疮肾炎,需要对先兆子痫进行仔细的鉴别诊断,记住怀孕期间的生理变化可能模仿狼疮发作。当存在抗磷脂抗体时,会出现主要并发症,如复发性流产、死产、FGR和母亲血栓形成。因此,一个多学科的方法是至关重要的,应该对所有育龄SLE妇女进行充分的孕前咨询,评估不良母婴结局的风险因素,并制定严格的妊娠监测计划。虽然治疗选择在怀孕期间是有限的,预防性抗聚集和抗凝剂已被证明有利于减少血栓事件和先兆子痫相关的发病率。药物治疗应该量身定制,让母亲和婴儿都有更好的结果。免疫抑制剂和免疫调节剂,必须有效地控制疾病活动,并在怀孕期间安全。羟氯喹是SLE的主要治疗方法,因为它具有抗炎和免疫调节作用,建议在怀孕前和怀孕期间使用,其他免疫抑制药物(如硫唑嘌呤和钙调磷酸酶抑制剂)用于控制疾病活动,以改善产科结局。管理产妇SLE是一项具有挑战性的任务,但与多学科团队密切监测的早期方法是必不可少的,可以改善产妇和胎儿的结局。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Systemic Lupus Erythematosus Pregnancy
Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology that often affects women during childbearing age. Pregnant women with SLE are considered high-risk patients, with pregnancy outcomes being complicated by high maternal and fetal mortality and morbidity. Obstetric morbidity includes preterm birth, fetal growth restriction (FGR), and neonatal lupus syndromes. Active SLE during conception is a strong predictor of adverse pregnancy outcomes and exacerbations of disease can occur more frequently during gestation. Therefore, management of maternal SLE should include preventive strategies to minimize disease activity and to reduce adverse pregnancy outcomes. Patients with active disease at time of conception have increased risk of flares, like lupus nephritis, imposing a careful differential diagnosis of pre-eclampsia, keeping in mind that physiological changes of pregnancy may mimic a lupus flare. Major complications arise when anti-phospholipid antibodies are present, like recurrent pregnancy loss, stillbirth, FGR, and thrombosis in the mother. A multidisciplinary approach is hence crucial and should be initiated to all women with SLE at childbearing age with an adequate preconception counseling with assessment of risk factors for adverse maternal and fetal outcomes with a tight pregnancy monitoring plan. Although treatment choices are limited during pregnancy, prophylactic anti-aggregation and anticoagulation agents have proven beneficial in reducing thrombotic events and pre-eclampsia related morbidity. Pharmacological therapy should be tailored, allowing better outcomes for both the mother and the baby. Immunosuppressive and immunomodulators, must be effective in controlling disease activity and safe during pregnancy. Hydroxychloroquine is the main therapy for SLE due to its anti-inflammatory and immunomodulatory effects recommended before and during pregnancy and other immunosuppressive drugs (e.g. azathioprine and calcineurin inhibitors) are used to control disease activity in order to improve obstetrical outcomes. Managing a maternal SLE is a challenging task, but an early approach with multidisciplinary team with close monitoring is essential and can improve maternal and fetal outcomes.
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