目的：探讨临床检查、实验室检查和多普勒超声检查对系统性红斑狼疮和/或抗磷脂综合征妊娠患者的预测价值。

方法：在一个单一的三级转诊中心对116例妊娠患者进行了前瞻性研究。分析的结果是胎儿/新生儿死亡和不良妊娠结局。对以下内容进行了单因素分析:(一)疾病史和产科病史;(二)体格检查和产科临床检查;(三)生物数据;(四)多普勒超声波检查。单因素分析中与结果显著相关的变量纳入logistic回归模型。

结果:116次妊娠中有16次妊娠终止其中于12次胎儿死亡和4次胎停。因此，对100例妊娠的数据进行了分析。其中7例胎儿死亡和1例新生儿死亡，与妊娠中期舒张末期脐动脉多普勒血流异常(P<0.006)、血栓性静脉炎(P<0.001)或子宫切口动脉和妊娠中期生长受限(P<0.002)有关。多因素分析中异常舒张末期脐动脉多普勒血流(P =0.047)和血栓性静脉炎史(P=0.018)作为显著预测因子。发生31例不良妊娠结局，分别与子宫切口动脉(P<0.00003)、舒张末期脐动脉多普勒血流异常(P<0.0006)和妊娠中期胎儿生长受限(P<0.008)、妊娠晚期生长受限(P<0.00001)和子宫切口动脉(P<0.0008)、肝素使用(P<0.05)和血栓性静脉炎史(P<0.04)有关。妊娠中期子宫切口动脉仍然是多因素分析中唯一的预测指标(P = 0.001)。

结论：妊娠中期多普勒超声检查结果是系统性红斑狼疮和/或抗磷脂综合征晚期妊娠结局的最佳预测指标。

附原文：

Objective: To examine the predictive value of clinicalexamination, laboratory tests and Doppler ultrasound examination in systemiclupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) pregnancies.

Methods: A prospective study of 116pregnancies followed in a single tertiary referral centre. Outcomes analysedwere fetal/neonatal death and adverse pregnancy outcome. Univariate analysiswas performed for: (i) medical and obstetric history; (ii) medical andobstetric clinical examination; (iii) biological data; (iv) Doppler ultrasoundexamination. Variables significantly associated with the outcomes in theunivariate analysis were entered into a logistic regression model.

Results: Sixteen out of 116 pregnancies ended in 12 fetal deaths and 4 embryonic losses.Hence, data for 100 pregnancies were analysed. Seven fetal deaths and one neonataldeath occurred, associated with abnormal end-diastolic umbilical artery Dopplerflow at the second trimester (P_0.006), a history of thrombophlebitis (P_0.001)or notched uterine artery and growth restriction at the second trimester(P_0.002). Multivariate analysis retained abnormal end-diastolic umbilicalartery Doppler flow (P ^ 0.047) and history of thrombophlebitis (P ^ 0.018) assignificant predictors. Thirty-one adverse pregnancy outcomes occurred,associated with notched uterine artery (P_0.00003), abnormal end-diastolicumbilical artery Doppler flow (P_0.0006) and fetal growth restriction at thesecond trimester (P_0.008), growth restriction (P_0.00001) and notched uterineartery at the third trimester (P_0.0008), use of heparin (P_0.05) and historyof thrombophlebitis (P_0.04). Notched uterine artery at the second trimesterremained the only predictor in multivariate analysis (P ^ 0.001).

Conclusions: Results of the second trimester Doppler ultrasound examination are the bestpredictors for late pregnancy outcome in SLE and/or APS.

引自：S. De Carolis et al.,Antiphospholipid syndrome: An update on risk factors for pregnancy outcome. Autoimmun Rev 17, 956-966 (2018).