摘要
目的探讨妊娠合并原发性干燥综合征(primary Sjögren's syndrome,pSS)的临床特点和pSS孕妇发生不良结局的相关因素。方法回顾性分析2017年2月至2022年8月就诊于广州医科大学附属第三医院产科的32例次妊娠合并pSS患者的临床资料,按照是否发生母儿不良结局分为不良结局组(20例次)和结局良好组(12例次),采用两独立样本t检验、Mann-Whitney U检验、Fisher精确概率法分析比较2组的临床特征差异,采用多因素logistic回归分析pSS孕妇发生不良结局的相关因素。结果(1)32例次pSS孕妇的年龄(32.9±4.6)岁,孕前体重指数(21.1±3.8)kg/m 2,分娩中位孕周37.8周(35.4~38.5周);孕前诊断18例次(56.3%,18/32),孕期诊断14例次(43.7%,14/32)。25例次(79.1%,25/32)孕妇孕期接受糖皮质激素和/或羟氯喹治疗,7例次(21.9%,7/32)孕期无药物治疗。(2)母体不良结局主要包括羊水过少(25.0%,8/32)、妊娠期高血压疾病(18.8%,6/32)、早产(18.8%,6/32)、胎儿生长受限(15.6%,5/32)、流产(12.5%,4/32)、妊娠期糖尿病(9.4%,3/32)和产后出血(3.1%,1/32)。(3)新生儿不良结局包括低出生体重儿7例(25.0%,7/28),新生儿窒息7例(25.0%,7/28),2例先天性心脏传导阻滞(7.1%,2/28)。(4)结局良好组的孕前诊断率高于不良结局组,差异有统计学意义[10/12与40.0%(8/20),Fisher精确概率法,P=0.028]。不良结局组与结局良好组的孕妇年龄、孕前体重指数、孕期体重增长、孕产次、自身抗体(抗核抗体、干燥综合征特异性抗体A、干燥综合征特异性抗体B、抗Ro-52抗体)阳性率、药物治疗(糖皮质激素、羟氯喹)的比例差异均无统计学意义(P值均>0.05)。(5)多因素logistic回归分析显示:孕前诊断(OR=0.02,95%CI:0.00~0.62,P=0.024)、抗干燥综合征特异性抗体B阳性(OR=0.01,95%CI:0.00~0.75,P=0.038)为pSS孕妇发生不良结局的保护因素。结论pSS孕妇的临床表现多样,不典型,多起病隐匿。孕前诊断、抗干燥综合征特异性抗体B
Objective To explore the clinical characteristics of pregnancy complicated by primary Sjögren's syndrome(pSS)and the related factors of adverse outcomes in pregnant women with pSS.MethodsA retrospective analysis was conducted on the clinical data of 32 pregnancies complicated by pSS treated in the Department of Obstetrics at the Third Affiliated Hospital of Guangzhou Medical University from February 2017 to August 2022.The patients were divided into two groups according to whether they had perinatal adverse outcomes:an adverse outcome group(n=20)and a favorable outcome group(n=12).The clinical characteristics of the two groups were compared with two independant sample t-test,Mann-Whitney U test,and Fisher's exact test,and multivariate logistic regression analysis was used to analyze the related factors of adverse outcomes in pregnant women with pSS.Results(1)The average maternal age of the 32 pSS pregnancies was(32.9±4.6)years,the pre-pregnancy body mass index was(21.1±3.8)kg/m 2,and the median gestational age at delivery was 37.8(35.4-38.5)weeks.There were 18 women(56.3%,18/32)were diagnosed before pregnancy and 14 women(43.7%,14/32)during pregnancy.Out of the 32 pregnancies,25(79.1%,25/32)received therapy with glucocorticoids and/or hydroxychloroquine during pregnancy,whereas seven(21.9%,7/32)had no medication during pregnancy.(2)The main adverse maternal outcomes included oligohydramnios(25%,8/32),hypertensive disorder of pregnancy(18.8%,6/32),preterm birth(18.8%,6/32),fetal growth restriction(15.6%,5/32),miscarriage(12.5%,4/32),gestational diabetes mellitus(9.4%,3/32),and postpartum hemorrhage(3.1%,1/32).(3)Adverse neonatal outcomes included low birth weight infants in seven cases(25.0%,7/28),neonatal asphyxia in seven cases(25.0%,7/28),and two cases of congenital heart block(7.1%,2/28).(4)The rate of diagnosis before pregnancy in the favorable outcome group was higher than the adverse outcome group[10/12 vs.40.0%(8/20),Fisher's exact test,P=0.028].There were no significant differences between the two grou
作者
杨师琪
陈菲
梁伟璋
李瑞瑞
宋晓磊
贺芳
Yang Shiqi;Chen Fei;Liang Weizhang;Li Ruirui;Song Xiaolei;He Fang(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Guangzhou Medical University(Guangdong Provincial Key Laboratory of Major Obstetric Diseases,Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology)Guangzhou 510515,China;Department of Obstetrics,Jincheng People's Hospital,Jincheng 048206,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2024年第8期643-648,共6页
Chinese Journal of Perinatal Medicine
基金
广东省基础与应用基础研究基金区域联合基金项目(2021B1515120070)。
关键词
原发性干燥综合征
妊娠
不良结局
Primary Sjogren's syndrome
Pregnancy
Adverse outcome
