摘要速递 | 一项针对244 例未分化结缔组织病妊娠的多中心研究：母胎结局和疾病演变

摘 要 速 递

题目：一项针对244 例未分化结缔组织病妊娠的多中心研究：母胎结局和疾病演变

期刊：Rheumatology (Oxford,England)

发表时间：2020年9月

关键词：抗核抗体；自身抗体；自身免疫性疾病；怀孕；妊娠并发症；未分化结缔组织病

ABSTRACT

摘要翻译

目的：评估在大型多中心队列中诊断为未分化结缔组织病的女性的母胎结局。

方法：这项多中心回顾性队列研究描述了133名诊断为未分化结缔组织病（UCTD）、抗核抗体（ANA）阳性且纳入研究时年龄为<45岁的女性224例连续妊娠的结果。

结果：在分析的224例妊娠中，177例（79%）为活产，45例（20.1%）为流产（定义为妊娠12周前流产），2例（0.9%）为死产（妊娠20周后流产），6例（2.7%）为宫内生长受限。孕产妇妊娠并发症如下：子痫前期5例（2.2%），妊娠期高血压11例（4.9%），妊娠期糖尿病12例（5.4%）。流产和死产与抗磷脂抗体和ENA抗体的存在密切相关（P < 0.05）。关节受累是该队列中最常见的临床表现（57.9%），其次是雷诺现象（40.6%）、光过敏（32.3%）和血液学表现（27.1%）。在我们的队列中，从确诊 UCTD 到确诊 CTD 的平均时间为 5.3 ± 2.8 年，疾病演变率为 12%。首次怀孕后的总随访时间为 1417 人-年(patient-years)，我们观察到每 88 人-年中就有一人被确诊为 CTD。

结论：在我们的多中心队列中，UCTD女性的活产率为79%。UCTD女性在计划怀孕时应转诊至专科医生随访。在这种情况下，ENA和aPL检测应是强制性的，并应相应地规划进一步的治疗和管理。

abstract

Objectives: To investigate fetal/perinatal and maternal outcomes from a large multi-centre cohort of women diagnosed with UCTD.

Methods: This multicentre retrospective cohort study describes the outcomes of 224 pregnancies in 133 consecutive women with a diagnosis of UCTD, positive for ANA and aged <45 years old at study inclusion.

Results: Of the 224 pregnancies analysed, 177 (79%) resulted in live births, 45 (20.1%) in miscarriages (defined as pregnancy loss before 12 weeks' gestation), 2 (0.9%) in stillbirths (pregnancy loss after 20 weeks' gestation) and 6 (2.7%) cases showed intrauterine growth restriction. Miscarriages and stillbirths were strongly associated with the presence of aPL and ENA antibodies (P < 0.05). Maternal pregnancy complications were as follows: 5 (2.2%) cases developed pre-eclampsia, 11 (4.9%) cases gestational hypertension and 12 (5.4%) cases gestational diabetes. Joint involvement represented the most frequent clinical manifestation of the cohort (57.9%), followed by RP (40.6%), photosensitivity (32.3%) and haematological manifestations (27.1%). The rate of disease evolution of our cohort from a diagnosis of UCTD to a diagnosis of definite CTD was 12% within a mean time of 5.3 ± 2.8 years. With a total follow-up after first pregnancy of 1417 patient-years, we observed the evolution to a defined CTD in one out of every 88 patient- years.

Conclusion: In our multicentre cohort, women with UCTD had a live birth rate of 79%. Women with UCTD should be referred to specialist follow-up when planning a pregnancy. ENA profiling and aPL testing should be mandatory in this setting, and further therapeutic approaches and management should be planned accordingly.

参考文献：

Radin M, Schreiber K, Cecchi I, Bortoluzzi A, Crisafulli F, de Freitas CM, Bacco B, Rubini E, Foddai SG, Padovan M, Gallo Cassarino S, Franceschini F, Andrade D, Benedetto C, Govoni M, Bertero T, Marozio L, Roccatello D, Andreoli L, Sciascia S. A multicentre study of 244 pregnancies in undifferentiated connective tissue disease: maternal/fetal outcomes and disease evolution. Rheumatology (Oxford). 2020 Sep 1;59(9):2412-2418.