全周期综合干预对风湿免疫性疾病患者妊娠结局的影响

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (949 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨全周期综合干预对风湿免疫性疾病患者妊娠结局的影响。方法以2021-01至2022-05解放军总医院第七医学中心收治的51例妊娠合并风湿免疫性疾病患者作为研究组,采用本研究团队建立的全周期综合干预方法及诊治流程对研究组进行干预,同时选取2015-01至2020-12该单位收治的55例妊娠合并风湿免疫性疾病患者作为对照组,比较两组间妊娠结局的差异。结果研究组子痫前期(5.89%)、胎儿生长受限(3.92%)、早产(15.69%)、原有疾病活动或加重(1.96%)的发生率明显低于对照组(分别为20.00%、16.36%、32.73%、12.73%,P均＜0.05)。对照组补体C₃(0.80±0.15)、C₄(0.11±0.03)水平明显低于研究组(分别为1.07±0.21、0.22±0.05,P均＜0.01),研究组免疫指标抗核抗体(35.29%)、抗SM抗体(9.80%)、抗dsDNA抗体(15.67%)、抗心磷脂抗体(23.53%)、抗β₂ 糖蛋白Ⅰ抗体(19.61%)、抗SSA 抗体(11.76%)、抗SSB 抗体(7.84%)阳性率明显低于对照组(分别为72.73%、27.27%、32.73%、41.82%、40%、27.27%、23.64%,P均＜0.05)。研究组选择剖宫产率(35.29%)明显高于对照组(18.18%,P<0.05),而总剖宫产率(41.18%)及产程剖宫产率(5.88%)明显低于对照组(分别为61.82%、43.64%,P<0.05)。研究组产后出血(3.92%)、胎膜早破(7.84%)、胎儿宫内窘迫(5.88%)、头盆不称(3.92%)的发生率均明显低于对照组(分别为16.36、23.64%、20.00%、18.18%,P<0.05)。研究组新生儿NICU入院(3.92%)、新生儿感染(9.80%)的发生率均明显低于对照组(分别为18.18%、27.27%,P<0.05)。结论全周期综合干预方法能明显改善妊娠合并风湿免疫性疾病患者的母儿妊娠结局,降低剖宫产率。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	王晶
	东星
	王心
	白云静
	刘昌峨
	张敏郁
	杨常栓
	张婕
	尚丽新

关键词 ：风湿免疫性疾病, 妊娠结局, 综合干预方法, 妊娠并发症

Abstract：Objective To explore the effect of whole-cycle comprehensive intervention on pregnancy outcomes of patients with rheumatic immune diseases (RID). Methods A total of 51 pregnant women with RID admitted to the Seventh Medical Center of PLA General Hospital from January 2021 to May 2022 were selected as the study group, which was intervened with the whole-cycle comprehensive intervention methods and diagnosis and treatment process established by our research team. At the same time, 55 cases of pregnant women with RID admitted to the hospital from January 2015 to December 2020 were selected as the control group. The differences of pregnancy outcomes among the two groups were compared. Results The incidences of preeclampsia (5.89%), fetal growth restriction (3.92%), preterm delivery (15.69%), original disease activity or aggravation (1.96%) in the study group were significantly lower than those in the control group (20.00%, 16.36%, 32.73%, 12.73%, P<0.05). The levels of complement C₃ (0.80±0.15) and C₄ (0.11±0.03) in the control group were significantly lower than those in the study group (1.07±0.21, 0.22±0.05, P<0.01), and the positive rates of immune indicators antinuclear antibody (35.29%), anti SM antibody (9.80%), anti dsDNA antibody (15.67%), anti cardiolipin antibody (23.53%), anti β₂ Glycoprotein I antibody (19.61%), anti SSA antibody (11.76%), anti SSB antibody (7.84%) in the study group were significantly lower than those in the control group (72.73%, 27.27%, 32.73%, 41.82%, 40%, 27.27%, 23.64%, P<0.05). The selective cesarean section rate (35.29%) in the study group were significantly higher than those in the control group (18.18%, P<0.05), while the total cesarean section rate (41.18%) and the cesarean section rate during labor (5.88%) were significantly lower than those in the control group (61.82%, 43.64%, P<0.05). The incidences of postpartum hemorrhage (3.92%), premature rupture of membranes (7.84%), fetal distress (5.88%) and cephalopelvic disproportion (3.92%) in the study group were significantly lower than those in the control group (16.36, 23.64%, 20.00%, 18.18%, P<0.05). The incidences of NICU admission (3.92%) and neonatal infection (9.80%) in the study group were significantly lower than those in the control group (18.18%, 27.27%, P<0.05). Conclusions The whole-cycle comprehensive intervention method can improve the maternal and fetal pregnancy outcomes and reduce the cesarean section rate.

Key words： rheumatic immune diseases pregnancy outcome comprehensive intervention methods pregnancy complication

收稿日期: 2023-04-09

ZTFLH:

R714

通讯作者: 尚丽新,E-mail:19932003@163.com

作者简介: 王晶,博士,副主任医师。

引用本文:

王晶, 东星, 王心, 白云静, 刘昌峨, 张敏郁, 杨常栓, 张婕, 尚丽新. 全周期综合干预对风湿免疫性疾病患者妊娠结局的影响[J]. 武警医学, 2023, 34(11): 963-967. WANG Jing, DONG Xing, WANG Xin, BAI Yunjing, LIU Change, ZHANG Minyu, YANG Changshuan, ZHANG Jie, SHANG Lixin. Effect of whole-cycle comprehensive intervention on pregnancy outcomes in patients with rheumatic immune diseases. Med. J. Chin. Peop. Armed Poli. Forc., 2023, 34(11): 963-967.

链接本文:

http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2023/V34/I11/963

[1]	Andreoli L, García F A, Chiara G M, et al. The course of rheumatic diseases during pregnancy[J]. Isr Med Assoc J, 2019, 21(7):464-470.
[2]	Pacini G, Paolino S, Andreoli L, et al. Epigenetics, pregnancy and autoimmune rheumatic diseases[J]. Autoimmun Rev, 2020, 19(12):102685-102696.
[3]	贺芳. 妊娠合并系统性红斑狼疮与不良妊娠结局[J]. 中国实用妇科与产科杂志, 2020, 36(5):412-416.
[4]	Castro G A, Young K, Bermas B L. Pregnancy and management in women with rheumatoid arthritis, systemic lupus erythematosus, and obstetric antiphospholipid syndrome[J].Rheum Dis Clin North Am, 2022, 48(2): 523-535.
[5]	Meissner Y, Fischer B R, Andreoli L, et al. EULAR recommendations for a core data set for pregnancy registries in rheumatology[J]. Ann Rheum Dis, 2021, 80(1):49-56.
[6]	Petri M. Pregnancy and systemic lupus erythematosus[J]. Best Pract Res Clin Obstet Gynaecol, 2020, 64(3): 24-30.
[7]	Dao K H, Bermas B L. Systemic lupus erythematosus management in pregnancy[J]. Int J Womens Health, 2022, 14(2):199-211.
[8]	Simard J F, Arkema E V, Nguyen C, et al. Early-onset preeclampsia in lupus pregnancy[J]. Paediatr Perinat Ep, 2017, 31(1) : 29-36.
[9]	Maria L U, Alessandra B, Irene M, et al. Comparison of treatments for the prevention of fetal growth restriction in obstetric antiphospholipid syndrome: a systematic review and network meta-analysis[J]. Intern Emerg Med, 2021, 16(5): 1357-1367.
[10]	Hansahiranwadee W. Diagnosis and management of fetal autoimmune atrioventricular block[J]. Int J Womens Health, 2020, 12(8): 633-639.
[11]	徐金凤, 陈代娟, 田园, 等. 风湿免疫性疾病的妊娠管理进展[J]. 实用妇产科杂志, 2021, 37(2): 97-100.
[12]	Littlejohn E A. Pregnancy and rheumatoid arthritis[J]. Best Pract Res Clin Obstet Gynaecol, 2020, 64(3): 52-58.
[13]	田新平,李梦涛,曾小峰. 从我国系统性红斑狼疮的诊治现状寻找可能的解决方案-来自《中国系统性红斑狼疮发展报告 2020》的启示[J]. 协和医学杂志, 2022, 13(2): 169-173.
[14]	Bangarusamy D K, Lakshmanan A P, Zaidan S, et al. Nutri-epigenetics: the effect of maternal diet and early nutrition on the pathogenesis of autoimmune diseases[J]. Minerva Pediatr (Torino), 2021, 73(2): 98-110.
[15]	Oláh C, Schwartz N, Denton C, et al. Cognitive dysfunction in autoimmune rheumatic diseases[J]. Arthritis Res Ther, 2020, 22(1): 78-85.
[16]	Calabrese L, Neiman D C. Exercise, infection and rheumatic diseases: what do we know?[J]. RMD Open, 2021, 7(2): e1644-1650.