Objective: To investigate the outcomes and associated factors for adverse pregnancy outcomes (APO) in pregnant patients with lupus nephritis (LN). Methods: The clinical data of 139 LN pregnant patients from from 2009 to 2017 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Results: Totally, 105 LN were diagnosed before pregnancy and 34 were newly diagnosed during pregnancy. One or more APO occurred in 71.2% of patients with LN and 40 (28.8%) were without any APO. Thirty-six (25.9%) of pregnancies resulted in fetal loss. A total of 54 pregnancies were preterm birth with 20 at gestational age <34 weeks, 13 were intrauterine growth retardation (IUGR), 3 were fetal distress, and 8 were neonatal lupus, pregnancy induced hypertension occurred in 18 cases, of which, 2 cases were gestational hypertension and 16 were preeclampsia. There was no eclampsia occurred.In multivariate analysis, predictors of APO included active lupus during pregnancy (OR=8.9, 95%CI: 3.7-21.7, P<0.001), rash (OR=7.3, 95%CI: 2.2-24.5, P=0.001), cylindruria (OR=5.3, 95%CI: 1.6-17.0, P=0.005) and antiphospholipid syndrome (OR=11.4, 95%CI: 1.5-88.3, P=0.02) were risk factors for pregnancy loss. Variables that were independently predictive of preterm birth included anticardiolipin antibody positive (OR=8.8, 95%CI: 1.5-51.5, P=0.02) and active lupus during pregnancy (OR=7.9, 95%CI: 2.3-24.5, P=0.001). Conclusions: Pregnancies in LN are still at high risk of APO in terms of pregnancy loss and preterm birth. Stable disease can help to reduce the risk of APO.
目的： 探讨狼疮肾炎患者妊娠结局及相关危险因素。 方法： 回顾性分析2009至2017年于中山大学附属第一医院就诊的139例狼疮肾炎妊娠患者(年龄19～38岁)的临床资料。 结果： 共34例为妊娠期初发狼疮肾炎，105例为妊娠前已确诊狼疮肾炎。99例(71.2%)发生1种或1种以上胎儿不良妊娠结局(APO)，40例(28.8%)未发生任何胎儿APO。36例(25.9%)发生妊娠丢失，103例(74.1%)活胎分娩，其中足月产49例，早产54例，胎儿宫内发育迟缓13例，宫内窘迫3例，新生儿狼疮8例。18例发生妊娠期高血压疾病，其中妊娠期高血压2例，子痫前期16例，无子痫患者。多因素Logistic回归分析结果显示，妊娠期间SLE病情活动(OR＝8.9，95%CI: 3.7～21.7，P<0.001)是胎儿APO的危险因素；皮疹(OR＝7.3，95%CI: 2.2～24.5，P＝0.001)、管型尿(OR＝5.3，95%CI: 1.6～17.0，P＝0.005)、抗磷脂综合征(OR＝11.4，95%CI: 1.5～88.3，P＝0.02)是妊娠丢失的危险因素；抗心磷脂抗体阳性(OR＝8.8，95%CI: 1.5～51.5，P＝0.02)和妊娠期间SLE病情活动(OR＝7.9，95%CI: 2.3～24.5，P＝0.001)是早产的危险因素。 结论： 狼疮肾炎患者不良妊娠结局发生率高，尤其是妊娠丢失和早产。控制狼疮肾炎患者妊娠期病情活动有利于减少胎儿APO的发生。.
Keywords: Adverse pregnancy outcomes; Lupus nephritis; Pregnancy loss; Preterm delivery.