【摘要】 目的:探讨抗磷脂抗体(aPL)对系统性红斑狼疮(SLE)患者、未分化结缔组织病(UCTD)患者孕期出现的超声不良事件(AE)、用药方案及不良妊娠结局(APO)的影响。方法:回顾分析47例SLE患者及54例UCTD患者单次妊娠事件的临床资料。结果:出现aPL的患者中，SLE患者的病程为4.0(2.0,10.3)年，显著大于UCTD患者[1.0(0.0,4.3)年],差异有统计学意义(P<0.05)。孕中期，UCTD＿aPL+组28例患者中18例(64.3%)出现AE,显著高于UCTD＿aPL-组[6/26(23.1%)],差异有统计学意义(P<0.05)。SLE组的尿蛋白阳性人数及尿总蛋白肌酐比值(Pr/Cr)显著高于UCTD组。APO除表现死胎、流产外，最常见的是新生儿低体重，各组患者发生率无显著差异。UCTD出现胎儿APO患者的狼疮抗凝物(LA)阳性率为62.5%,显著高于UCTD＿非APO组(21.7%)。SLE＿APO组孕中期出现胎儿生长受限(FGR)率为41.7%,显著高于SLE＿非APO组(11.4%)。Logistic回归分析结果显示，合并aCL-IgG抗体阳性的SLE患者易出现胎儿APO事件(P=0.016),出现LA阳性的UCTD患者也更易发生胎儿APO事件(P=0.017)。结论:aPL阳性及孕期出现FGR与SLE、UCTD患者胎儿APO结局明显相关，及时抗凝和加强免疫治疗为挽救措施。更多还原

【Abstract】 Objective:To analyze the impact of antiphospholipid antibodies(aPL) on ultrasound-detected adverse events(AE),medication regimens, and adverse pregnancy outcomes(APO) in pregnant patients with systemic lupus erythematosus(SLE) and undifferentiated connective tissue disease(UCTD).Methods:A retrospective analysis was conducted on clinical data from 47 SLE patients and 54 UCTD patients with singleton pregnancies.Results:SLE patients with aPL had significantly longer disease duration [4.0(2.0,10.3) years] than UCTD patients [1.0(0.0,4.3) years].In the second trimester, 18/28 patients(64.3%) in the UCTD＿aPL+ group experienced adverse events(AEs),which was significantly higher than the 6/26 patients(23.1%) in the UCTD＿aPL-group.Additionally, the SLE group had a significantly higher number of patients with positive urine protein and a higher urine total protein-to-creatinine ratio(Pr/Cr) compared to the UCTD group.Low neonatal birth weight was the most common APO,though incidence rates did not differ significantly between groups.However, aPL positivity strongly correlated with APO:UCTD patients with fetal APO had a lupus anticoagulant(LA) positivity rate of 62.5% was significantly higher than the 21.7%,in UCTD patients without APO.SLE patients with APO exhibited a second-trimester fetal growth restriction(FGR) rate of 41.7%,was significantly higher than the 11.4% in SLE patients without APO.Logistic regression analysis identified the following APO risk factors: SLE patients positive for aCL-IgG antibodies faced increased odds of fetal adverse pregnancy events(P=0.016).LA-positive UCTD patients showed heightened fetal APO risk(P=0.017).Conclusion:aPL positivity is significantly associated with adverse pregnancy outcomes(APOs) in SLE patients, while fetal growth restriction(FGR) during pregnancy is significantly linked to APOs in UCTD patients.Prompt anticoagulation and intensified immunosuppressive therapy may serve as salvage measures to mitigate adverse outcomes.更多还原