背景:目前针对于系统性红斑狼疮对患者的影响及其妊娠并发症的研究尚存在诸多相互矛盾性的结果。既往研究的缺点主要是研究对象数量不足以及回顾性研究分析。本研究针对狼疮女性妊娠结局进行系统的文献综述，并对狼疮肾炎与不良妊娠结局的关联进行荟萃分析。

研究设计、研究对象、方法：我们搜索时限从1980年到2009年的电子数据库，并审查了论文的有效性，用随机效应分析方法用于评估妊娠并发症发生率。

结果：总共包括1842例患者和2751例怀孕的37项研究。产妇并发症包括狼疮复发(25.6%)，高血压(16.3%)，肾炎(16.1%)，先兆子痫(7.6%)和子痫(0.8%)。 诱导流产率为5.9%。胎儿并发症包括自发流产(16.0%)，死胎(3.6%)，新生儿死亡(2.5%)和子宫内生长迟缓(12.7%)。 非成功妊娠率为23.4%，早产率为39.4%。 Meta回归分析显示活动性肾炎或肾炎史患者的早产率和活动性肾炎之间呈正相关，并且高血压发病率显著升高。 肾炎史也与先兆子痫相关。 抗磷脂抗体与高血压，早产以及增加的流产率有关。

结论：在狼疮患者中，狼疮性肾炎和抗磷脂抗体增加了母体高血压以及胎儿早产的风险。相对于狼疮活动的患者，其妊娠时需要提前规划并需要更多的护理。

附原文

Background and objectives: Studies of the impact of systemic lupus erythematosus (SLE) and its pregnancy complicationshave yielded conflicting results. Major limitations of these studies relate to their small numbers of patients and retrospectivedesigns. The aim of this study was to perform a systematic literature review of pregnancy outcomes in women with SLE anda meta-analysis of the association of lupus nephritis with adverse pregnancy outcomes.Design, setting, participants, & measurements: We searched electronic databases from 1980 to 2009 and reviewed paperswith validity criteria. Random-effects analytical methods were used to evaluate pregnancy complications rates.Results: Thirty-seven studies with 1842 patients and 2751 pregnancies were included. Maternal complications includedlupus flare (25.6%), hypertension (16.3%), nephritis (16.1%), pre-eclampsia (7.6%), and eclampsia (0.8%). The induced abortionrate was 5.9%, and when excluded, fetal complications included spontaneous abortion (16.0%), stillbirth (3.6%), neonataldeaths (2.5%), and intrauterine growth retardation (12.7%). The unsuccessful pregnancy rate was 23.4%, and the prematurebirth rate was 39.4%. Meta-regression analysis showed statistically significant positive associations between premature birthrate and active nephritis and increased hypertension rates in subjects with active nephritis or a history of nephritis. Historyof nephritis was also associated with pre-eclampsia. Anti-phospholipid antibodies were associated with hypertension,premature birth, and an increased rate of induced abortion.Conclusions: In patients with SLE, both lupus nephritis and anti-phospholipid antibodies increase the risks for maternalhypertension and premature births. The presented evidence further supports timing of pregnancy relative to SLE activity andmultispecialty care of these patients.

引自

Andrew SmythA Systematic Review and Meta-Analysis of PregnancyOutcomes in Patients with Systemic Lupus Erythematosusand Lupus NephritisClin J Am Soc Nephrol 5: 2060–2068, 2010. doi: 10.2215/CJN.00240110.