Background Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age and is often associated with adverse pregnancy outcomes (APOs). Antiphospholipid antibodies (aPLs) are known risk factors for APOs in the general population, and the prevalence of aPLs is higher in patients with SLE than healthy women. Objective This study aimed to investigate the impacts of aPLs and different aPLs profiles on pregnancy outcomes in patients with SLE. Study design This study analysed data from a single-centre SLE cohort in China. aPLs profiles, including anticardiolipin antibodies (aCL) IgG/IgM, anti-β2 glycoprotein I (anti-β2GPI) antibodies IgG/IgM and lupus anticoagulant (LA), were measured. APOs were defined as prefetal death, fetal death, pre-eclampsia with severe features occurring before 34 weeks of gestation and placental insufficiency with severe features occurring before 34 weeks of gestation. Results The study comprised 441 singleton pregnancies occurring in 410 patients with SLE and 78 (17.9%) were positive for aPLs. Seventy-one (16.1%) patients developed APOs and 391 (88.7%) patients succeeded in giving a live birth. Patients with positive aPLs experienced APOs more frequently (29.5% vs 13.2%), with an OR of 2.56 (95% CI 1.38 to 4.65, p=0.002). aPLs were also associated with higher risks of fetal death (OR 3.87, 95% CI 1.17 to 12.19, p=0.021) and failure of live birth (OR 2.54, 95% CI 1.22 to 5.15, p=0.011). Analysis on the aPLs profiles revealed that aCL IgG (OR 3.02, 95% CI 1.44 to 6.15, p=0.003), anti-β2GPI IgG antibodies (OR 2.60, 95% CI 1.13 to 5.72, p=0.020) and LA (OR 2.85, 95% CI 1.44 to 5.56, p=0.002) increased the risks of APOs significantly, but aCL IgM and anti-β2GPI IgM antibodies did not. Further analysis demonstrated that LA plus IgG isotypes of aCL and/or anti-β2GPI antibodies was the highest-risk profile, increasing the incidences of APOs with an OR of 3.98 (95% CI 1.66 to 9.35, p=0.002), while the other combinations of aPLs positivity did not (OR 1.82, 95% CI 0.81 to 3.81, p=0.128). Conclusion This study demonstrated the adverse effects of aPLs in patients with SLE regarding the pregnancy outcomes, and different aPLs profiles displayed distinct impacts. This highlights the importance of risk stratification when managing pregnancy among patients with SLE, putting more focus on those with positive aPLs, especially those positive for LA plus IgG isotypes of aCL and/or anti-β2GPI antibodies.

Objectives To characterize gestational weight gain (GWG) in pregnant women with systemic lupus erythematosus (SLE) and analyze its association with neonatal birth weight. Methods This retrospective cohort study included singleton pregnancies with SLE delivered at Peking Union Medical College Hospital (PUMCH) between June 2020 and September 2025, all of whom were definitively diagnosed by the Department of Rheumatology and Clinical Immunology. Each SLE case was matched 1:2 with non-SLE controls by age, prepregnancy body mass index, and parity. GWG patterns were described using Chinese standards. Factors associated with weight gain were analyzed using chi-square and nonparametric tests. Multivariate logistic regression models assessed associations between GWG and birthweight outcomes. Results A total of 160 SLE pregnancies and 320 controls were included. In the SLE group, 30.6%, 43.8%, and 25.6% had total GWG below, within, and above Chinese standards, respectively; for mid-late gestational weight gain rate (GWGR), the proportions were 15.0%, 41.9%, and 43.1%. Compared with controls, SLE pregnancies had a higher prevalence of both total GWG and mid-late GWGR falling below the Chinese standards (P < 0.001). SLE disease activity (10/160, 6.25%) and corticosteroid use (125/160, 78.1%) were not associated with mid-late GWGR categories (P > 0.05). The incidences of full-term low birth weight (LBW) and small for gestational age (SGA) were 7.5% and 17.5%, whereas macrosomia and large for gestational age (LGA) were rare (0.6% and 3.8%, respectively). Multivariate logistic regression adjustment for confounding factors showed that a slow mid-late GWGR (< P-25) significantly increased the risk of full-term LBW compared to an appropriate GWGR (P-25-P-75) [adjusted odds ratio (aOR) = 6.560, 95% CI: 1.53-28.12, P = 0.011]. Conclusion Pregnant women with SLE exhibit a distinct weight gain pattern characterized by a high rate of inadequate total GWG and GWGR. Oral glucocorticoids did not contribute to additional weight gain. Notably, slow mid-late GWGR was associated with an increased risk of full-term LBW. In clinical practice, improved monitoring, risk assessment, and management of pregnant women with inadequate gestational weight gain are warranted.

OBJECTIVE:To evaluate the clinical utility of serial foetal echocardiographic surveillance, specifically atrioventricular interval (AVI) monitoring, in managing anti-SSA/Ro-SSB/La-Positive SLE pregnancies. METHODS:SLE pregnancies with positive anti-SSA/Ro-SSB/La antibodies were retrospectively included (n = 50). Pregnancies were stratified into two groups based on whether optimal pre-gestational conditions were met. All pregnancies underwent serial foetal echocardiography, including structural assessment and precise AVI measurement. RESULTS:The overall incidence of foetal cardiac conduction abnormalities was 12% (6/50). The incidence was significantly higher in the suboptimal-conditions group (Group 2, 26% [5/19]) compared with the optimal-conditions group (Group 1, 3% [1/31]) (P = 0.024). Through close monitoring, one foetus with persistent AVI prolongation received dexamethasone and intravenous immunoglobulin, successfully preventing progression to advanced heart block; the other five cases normalized spontaneously upon short-term follow-up, avoiding overtreatment. CONCLUSION:SLE pregnancies with anti-SSA/Ro-SSB/La antibodies and suboptimal gestational conditions constitute a distinct high-risk subgroup. A management strategy through risk-stratified serial foetal AVI monitoring allows for precise treatment identification, significantly improving neonatal outcomes while avoiding unnecessary interventions.

Systemic lupus erythematosus (SLE) presents with heterogeneous clinical manifestations and pregnancy outcomes, complicating its pregnancy management. This study aimed to identify distinct subgroups of pregnant SLE patients and explore their prognostic implications. In this multicenter cohort study across 45 centers in China, 25 baseline variables were incorporated into a cluster analysis (CA) considering collinearity and clinical relevance. Pregnancy outcomes were compared across clusters, and logistic regressions were conducted for total adverse pregnancy outcome (APO) in the overall cohort and each cluster. Among 528 pregnancies in 499 patients, 72.7

There is a scarcity of long-term follow-up studies on the offspring of mothers with systemic lupus erythematosus (SLE) in mainland China, due to the limited number of live births over the past decade. This study aims to report the long-term health of SLE offspring and the factors to affect health. This is an observational study of an ambispective cohort. We collected data through questionnaires and medical records. Peripheral venous blood samples were collected to test autoimmune parameters. The Wechsler Intelligence Scale was used to evaluate the neurological and psychiatric development. Children were born between August 1, 2007, and April 30, 2013, in Peking Union Medical College Hospital. Their mothers were diagnosed with SLE. Children were 12–16 years old during the follow-up period. We analyzed the occurrence rates of diseases and risk factors. A total of 63 children were recruited. The ratio of males to females was 1.25:1, and 79.4

Systemic lupus erythematosus (SLE) is frequently associated with a lower rate of live birth and a higher incidence of adverse pregnancy outcomes (APOs), and pregnancy can also increase the risk of SLE flares. Comprehensive preconception assessment is critical for improved pregnancy outcomes in patients with SLE. Unfortunately, no global consensus on the conditions that patients with SLE should fulfill prior to pregnancy has yet been formed. This study aimed to investigate the conditions that patients with SLE should fulfill before pregnancy to optimize outcomes. This was a retrospective study utilizing data from a multicenter Chinese SLE cohort. Information on demographics, obstetric history, SLE activity, clinical manifestations, autoantibody profiles, laboratory parameters, therapeutics, and pregnancy outcomes was collected. Logistic regression was used to explore the optimal conditions. The study comprised 347 singleton pregnancies from 332 patients with SLE in total, with a mean maternal age at conception of 30.3 (SD 4.0) years. The analysis revealed that patients who were stable for at least 6 months, had no active vital organ involvement, were on nonfluorinated corticosteroids no more than the dose equivalent to prednisone 7.5 mg per day, and were on hydroxychloroquine displayed a significantly higher incidence of live birth (86.1

Objective To evaluate the association of PIGF and sFlt-1 with low-birth-weight and/or small-for-gestational-age neonates in pregnancy with or without preeclampsia. Methods Singleton pregnancies with sFlt-1/PlGF tested were included and set into four groups for case-control analysis. Distribution of sFlt-1/PlGF, sFlt-1 and PlGF, PGF% were evaluated, Kruskal-Wallis test and Mann-Whitney U test were adopted for significance analysis. Results Maternal sFlt-1/PlGF, PlGF, PlGF% and sFlt-1 were statistically associated with low birth weight and/or small for gestational age in pregnancy complicated or uncomplicated with preeclampsia. A significant difference was shown on sFlt-1/PIGF (P=0.0082), PIGF% (P=0.0326), PIGF (P=0.0128) and sFlt-1 (P=0.0469) in pregnancy with small-for-gestational-age and/or low-birth-weight neonates. A significantly higher median of sFlt-1/PlGF (448 vs 61.6, P<0.0001) and sFlt-1 (15499 vs 3226, P<0.0001), a significantly lower median of PlGF (33.92 vs 115.2, P<0.0001) and PlGF% -76.63 vs -20.31, P<0.0001) were demonstrated, respectively, when preeclampsia with small-for-gestational-age and/or low-birth-weight neonates was compared to preeclampsia with normal birth-weight neonates. No significant difference was demonstrated between low birth weight and small for gestational age on sFlt-1/PlGF, PlGF, PlGF% and sFlt-1. Conclusion sFlt-1/PlGF seems to be promising biomarkers in predicting low-birth-weight and/or small-for-gestational-age neonates in pregnancy with or without preeclampsia.

To synthesize available evidence on predictive factors associated with systemic lupus erythematosus (SLE) flares during pregnancy, we systematically searched MEDLINE, Embase, and the Cochrane Library through January 2024 for observational studies on risk and protective factors of SLE flares during pregnancy. Odds ratios (OR) and mean differences (MD), as well as their 95

Systemic lupus erythematosus (SLE) is often related to a lower rate of live birth and a higher incidence of adverse pregnancy outcomes (APOs), and pregnancy can lead to an increased risk of SLE flares. Comprehensive preconception assessment is crucial, but global consensus regarding the criteria the patients should meet before pregnancy has not been formed yet. This study, conducted retrospectively based on data from Chinese SLE Treatment and Research group (CSTAR) registry, a multicenter Chinese SLE cohort, aimed to investigate the optimal criteria. Analysis included 347 singleton pregnancies from 333 patients with SLE in total. The criteria that patients with SLE should meet before pregnancy were identified by univariate logistic regression analysis, which were: 1) disease stable for at least 6 months; 2) absent of vital organ damage; 3) on nonfluorinated corticosteroids no more than the dose equivalent to prednisone 7.5mg per day; 4) on hydroxychloroquine. The proportion of live birth was significantly higher in the group meeting the criteria (86.1% vs 73.7%, p=0.004). Furthermore, the gestational week at delivery (38.4 vs 37.6, p<0.001) and the birthweight (2956.7g vs 2810.2g, p=0.004) were significantly larger. Then, APOs occurred less frequently in the group meeting the criteria (29.4% vs 52.1%, p<0.001). For each type of APOs, the incidences of therapeutic abortion (5.0% vs 12.0%, p=0.019), preterm delivery (14.2% vs 33.3%, p<0.001), and preeclampsia (1.1% vs 5.4%, p=0.023) were remarkably lower. When it comes to disease flares, patients in group meeting the criteria experienced flares during pregnancy less frequently (14.7% vs 28.1%, p=0.005), as well as for severe flares (5.8% vs 15.6%, p=0.006). Results were similar when taking both gestation period and one year postpartum into consideration. The results of this study stress the importance of comprehensive preconception assessment and warrant the implementation of such criteria among patients with SLE in clinical practice.

Objectives: This study aimed to evaluate the outcomes of pregnancy in patients with systemic lupus erythematosus (SLE). It focused on identifying clinical and laboratory markers that could predict the common adverse pregnancy outcomes (APOs) after 20 weeks of gestation, namely preeclampsia (PE) and preterm birth (PTB) in them. Methods: Pregnant SLE women who delivered at the study center from 2010 to 2023 were retrospectively analyzed. Categorical variables were evaluated using the chi-square test or Fisher?s exact test, while continuous variables underwent Mann?Whitney U testing. Stepwise regression was used to assess the predictors of pregnancy outcomes. Results: The study enrolled 445 pregnancies in 408 women diagnosed with SLE. Of these, 202 pregnancies (45.4%) resulted in at least one APO. Disease flare-ups, hypertension, and proteinuria during the first trimester were primary predictors of at least one APO and PTB. The most frequently recorded maternal adverse outcome was PE (14.6%), while PTB accounted for 32.6% of fetal adverse outcomes. Multivariate regression analysis identified hypertension, history of PE, associated antiphospholipid syndrome (APS), proteinuria, and low serum C4 in the first trimester as independent risk factors for PE. Regular follow-ups at our center correlated with lower risks of APOs, PE, and PTB. APS also emerged as a risk factor for PTB, whereas the use of hydroxychloroquine (HCQ) during pregnancy seemed to protect against PTB. Conclusion: For pregnancies complicated by SLE, we recommend early pregnancy screening for proteinuria?even in the absence of lupus nephritis?as well as continued use of HCQ and routine prenatal care throughout pregnancy.

Pre-eclampsia (PE) is a severe pregnancy complication that is more common in patients with systemic lupus erythematosus (SLE). Although the exact causes of these conditions are not fully understood, the immune system plays a key role. To investigate the connection between SLE and PE, we analyzed genes associated with SLE that may contribute to the development of PE. We collected 9 microarray data sets from the NCBI GEO database and used Limma to identify the differentially expressed genes (DEGs). In addition, we employed weighted gene co-expression network analysis (WGCNA) to pinpoint the hub genes of SLE and examined immune infiltration using Cibersort. By constructing a protein-protein interaction (PPI) network and using CytoHubba, we identified the top 20 PE hub genes. Subsequently, we created a nomogram and conducted a receiver operating characteristic (ROC) analysis to predict the risk of PE. Our analysis, including gene set enrichment analysis (GSEA) and PE DEGs enrichment analysis, revealed significant involvement in placenta development and immune response. Two pivotal genes, BCL6 and MME, were identified, and their validity was confirmed using 5 data sets. The nomogram demonstrated good diagnostic performance (AUC: 0.82-0.96). Furthermore, we found elevated expression levels of both genes in SLE peripheral blood mononuclear cells (PBMCs) and PE placental specimens within the case group. Analysis of immune infiltration in the SLE data set showed a strong positive correlation between the expression of both genes and neutrophil infiltration. BCL6 and MME emerged as crucial genes in lupus-related pregnancies associated with the development of PE, for which we devised a nomogram. These findings provide potential candidate genes for further research in the diagnosis and understanding of the pathophysiology of PE.

BACKGROUND:The 2023 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) antiphospholipid syndrome (APS) classification criteria were developed with higher specificity but lower sensitivity compared with the 2006 Sydney revised classification criteria. OBJECTIVES:To validate the performance of the 2023 ACR/EULAR APS classification criteria in a large Chinese APS cohort. METHODS:This was a single-center cohort study. Inclusion criteria aligned with the entry criteria of 2023 criteria. APS classification by "expert consensus panel" served as the gold standard. Sensitivity and specificity were compared between the 2023 and 2006 criteria. RESULTS:A total of 526 patients with a mean age of 38.55 ± 12.67 years were enrolled, of whom 366 (69.58%) were female and 182 (34.60%) had systemic lupus erythematosus (SLE). Among them, 407 (77.38%) patients were classified as APS by experts. The 2023 criteria demonstrated higher overall specificity than the 2006 criteria (0.983 vs 0.950), while sensitivity was relatively lower (0.818 vs 0.853). The sensitivity of the 2023 criteria improved for patients with SLE (0.860 vs 0.825), microvascular manifestations (0.867 vs 0.786), cardiac valve disease (0.903 vs 0.774), and thrombocytopenia (0.811 vs 0.790). Reduced sensitivity of the 2023 criteria was linked to the omission of certain microvascular manifestations, a stricter definition of pregnancy morbidity, and the exclusion of isolated thrombocytopenia and isolated IgM isotype antiphospholipid antibodies from meeting clinical and laboratory criteria, respectively. CONCLUSION:The 2023 criteria offer higher overall specificity and improved sensitivity in specific patient subsets, such as those with SLE, microvascular manifestations, cardiac valve disease, and thrombocytopenia when compared with the 2006 criteria.

Systemic lupus erythematosus (SLE), an autoimmune condition, presents pregnancy-related risks, impacting maternal and fetal health. The immune cell composition and gene expression profiles in pregnant SLE patients, as well as the molecular mechanisms of active SLE patients during pregnancy, remain unclear. In our study, we enrolled 12 patients: three active SLE individuals (SLE-AT group, SLEDAI > 12, non-pregnant women), three inactive SLE individuals (SLE-NP group, SLEDAI ranging 0 to 6, non-pregnant women), three pregnant women with active SLE (SLE-C group, SLEDAI > 12), and three pregnant women with inactive SLE (SLE-NC group, SLEDAI range 0 to 6 score). Transcriptome analysis of peripheral blood mononuclear cells (PBMCs) was conducted using the 10x Genomics technique. We observed upregulation of genes like CCDC15 and TRBV4-2 in T cells and CMPK2, IFIT1, and OAS2 in monocytes in the SLE-C group. Notably, gene sets related to Cell Cycle and IFN Response showed significant differences between the SLE-C and SLE-NC groups in naïve CD8 T cells. Our comparison of immune cell type ratios and transcriptional patterns between active and inactive SLE during pregnancy sheds light on the single-cell level changes in SLE status during pregnancy, offering insights for future SLE prediction and treatment strategies.

Arisaema cum Bile (Dan Nanxing in Chinese, DNX) have been employed to treat allergic asthma. However, the active components and its mechanisms remain unknown. Therefore, the systematic pharmacology approach-experimental validation was performed in this study. Each 5, 6, and 10 compounds of DNX were obtained by HPLC analysis, TCMSP, and literature report, respectively. A total of 379 targets on all these compounds were acquired from Swiss Target Prediction, and 1973 targets on allergic asthma were predicated. The KEGG enrichment analysis was performed. Furthermore, a rat model of allergic asthma was established and DNX (450 mg/kg, p.o.) was given for 2 weeks. DNX treatment prevented OVA-induced pathological changes in lung cell of irregular arrange and necrotic bronchial epithelial. It also decreased inflammatory cytokines IL-4, IL-5, and IL-13 of serum and BALF, and increased IL-12 and IFN-γ. The main MAPK signaling pathway predicted by KEGG enrichment was verified, as indicated by the decreased protein expression of JNK (p < 0.05 & p < 0.01), ERK (p < 0.05), and p38 MAPK (p < 0.01) in lung tissue. These findings indicated that DNX attenuated OVA-induced allergic asthma mainly by decreasing the MAPK signaling pathway.

This study explored the efficacy and safety of transcutaneous auricular vagus nerve stimulation (ta-VNS) in patients with epilepsy. A total of 150 patients were randomly divided into active stimulation group and control group. At baseline and 4, 12, and 20 weeks of stimulation, demographic information, seizure frequency, and adverse events were recorded; at 20 weeks, the patients underwent assessment of quality of life, Hamilton Anxiety and Depression scale, MINI suicide scale, and MoCA scale. Seizure frequency was determined according to the patient's seizure diary. Seizure frequency reduction > 50% was considered effective. During our study, the antiepileptic drugs were maintained at a constant level in all subjects. At 20 weeks, the responder rate was significantly higher in active group than in control group. The relative reduction of seizure frequency in the active group was significantly higher than that in the control group at 20 weeks. Additionally, no significant differences were shown in QOL, HAMA, HAMD, MINI, and MoCA score at 20 weeks. The main adverse events were pain, sleep disturbance, flu-like symptoms, and local skin discomfort. No severe adverse events were reported in active and control group. There were no significant differences in adverse events and severe adverse events between the two groups. The present study showed that ta-VNS is an effective and safe therapy for epilepsy. Furthermore, the benefit in QOL, mood, and cognitive state of ta-VNS needs further validation in the future study although no significant improvement was shown in this study.

Abstract Systemic lupus erythematosus (SLE), a prevalent autoimmune disease predominantly affecting women of childbearing age, presents ongoing challenges despite notable advances in diagnosis and treatment. Although survival rates for SLE patients have significantly improved, pregnancy continues to pose a considerable obstacle. Addressing this critical need for enhanced reproductive and prenatal care, there is a pressing imperative to establish standardized protocols for peri-gestational monitoring and treatment in SLE patients. This guideline is jointly sponsored by the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR), and the Chinese Research Committee of Pregnancy and Reproduction in Autoimmune Rheumatic Diseases (CHOPARD). Thirteen pertinent clinical questions have been generated through several rounds of rigorous clinical and methodological expert discussions and selections for a comprehensive understanding of key aspects in this domain. Guided by thorough examination of research evidence and expert perspectives, the formulated recommendations aim to optimize pregnancy success rates, reduce maternal and infant mortality rates, and ultimately enhance the overall well-being of SLE patients.

Antiphospholipid antibodies (aPLs) are the leading causes of adverse pregnancy outcomes (APOs). We conducted cluster analysis to identify distinct phenotypes among aPLs-associated APOs patients. This approach aims to facilitate risk stratification and improve pregnancy outcomes for obstetric APS. This was a retrospective study of persistent aPLs positive women cohort in Peking Union Medical College Hospital. Baseline demographic characteristics, clinical manifestation, previous APOs and antibodies profiles were included for hierarchical cluster analysis. Placentae from portions of patients were collected and performed the histopathologic diagnoses. Four clusters among 209 patients with 477 pregnancies were identified. Cluster 1 comprised patients with triple aPLs positivity and demonstrates a high incidence of gestational hypertension (34.92%, P < 0.05) and preterm delivery (20.63%, P < 0.05). Patients in cluster 2 were characterized by lupus anticoagulant (LA) positivity, with high risk of whole gestational APOs. Cluster 3 included patients with isolated aPLs-IgM isotype combined with early miscarriage (60.92%, P = 0.016). Patients in cluster 4 majorly presented aPLs-IgG isotype combined with placenta insufficiency (22.73%). During the follow-up, the live birth rate in cluster 1 and 2 was only 69.20%. Placenta pathology revealed the most severe impairment within cluster 1, whereas clusters 3 and 4 exhibited relatively milder damage. By cluster analysis, we identified four clinical subtypes of aPLs-associated APOs patients. Patients with triple antibodies or high-risk lupus characteristics were prone to occurred gestational hypertension and premature delivery. Isolated LA or aCL/a beta 2GPI positivity were found to be more frequently associated with early-stage fetal loss.

自身免疫性疾病在妊娠期并不少见,很多是在妊娠期首次被确诊.这些妊娠期表现出来的自身免疫性疾病(autoimmune disease,AID)究竟是"新发生",还是在妊娠期被首次发现,是一个值得探讨的问题.由于这些AID会导致一些不良妊娠结局,在妊娠期如何识别这些AID并及早给予相应处理,对改善不良妊娠结局至关重要.

Objectives: To investigate the pregnancy outcomes of patients with Takayasu arteritis (TAK) and identify the relevant risk factors. Methods: A total of 110 pregnancies in 80 patients in a Chinese TAK cohort and 550 matched pregnancies in healthy women between 2000 and 2020 were included. The pregnancy outcomes between patients and controls were compared by Fisher ' s exact test. Logistic regression analysis was used to identify risk factors for adverse pregnancy outcomes and maternal complications in patients with TAK. Results: In this case-control study, our results have demonstrated that adverse pregnancy outcomes are more frequent in TAK patients than those in healthy women (P < 0.001). The most common maternal complication was new-onset or worsening hypertension (18.2% [20/110]), and the most prevalent fetal complication was spontaneous abortion (32.7% [36/110]). Adverse pregnancy outcomes were significantly associated with hypertension (adjusted OR 2.67 [95% CI, 1.02-6.98]), renal artery involvement (adjusted OR 2.87 [95% CI, 1.10-7.51]) before pregnancy, and active disease during pregnancy (adjusted OR 11.64 [95% CI, 1.45-93.28]). The increased maternal complications were significantly associated with hypertension (adjusted OR 5.21 [95% CI, 1.70-15.95]), renal artery involvement (adjusted OR 5.36 [95% CI, 1.73-16.58]), heart disease (adjusted OR 7.96 [95% CI, 1.21-52.47]) and active TAK (adjusted OR 9.72 [95% CI, 2.58-36.65]) before pregnancy. Use of antiplatelet agents during pregnancy was associated with a reduced risk of maternal complications (adjusted OR 0.36 [95% CI, 0.13-0.97]). Conclusion: Maternal and fetal complications are associated with TAK. Effective control of TAK disease activity, surgical correction of renal artery stenosis, tight control of hypertension, use of antiplatelet agents, and close monitoring by physicians are important to improve pregnancy outcomes.

目的 探讨抗磷脂综合征(APS)并发子痫前期(PE)/子痫患者的临床特点、妊娠结局及难治性产科抗磷脂综合征(难治性OAPS)的相关诊治策略.方法 回顾性分析2009年6月至2021年5月在北京协和医院住院治疗的203例APS患者的临床资料,其中合并PE/子痫的15例患者为研究组,未合并PE/子痫的188例患者为对照组.比较两组患者的临床特点、干预情况及妊娠结局,并分析难治性OAPS的治疗及转归情况.结果 研究组和对照组患者的平均年龄无显著性差异(P＞0.05).研究组中合并系统性红斑狼疮(SLE)(60.0％vs.13.3％)和既往存在不良孕产史的比例(40.0％vs.14.4％)显著高于对照组(P＜0.05);两组间合并胎膜早破、胎盘早剥、胎儿生长受限(FGR)、血小板减少及血栓栓塞的发生率均无显著性差异(P＞0.05).两组患者的干预措施中,单用阿司匹林、单用低分子肝素及联合使用阿司匹林和低分子肝素的比例均无显著性差异(P＞0.05).终止妊娠方式比较,研究组的剖宫产率(90.9％)显著高于对照组(56.9％)(P＜0.05).妊娠结局比较,研究组的活产率显著低于对照组(60.0％vs.96.3％,P＜0.05),而胎死宫内发生率(40.0％vs.3.2％)、早产率(54.5％vs.5.0％)、新生儿窒息率(23.3％vs.3.3％)均显著高于对照组(P均＜0.05).共纳入9例难治性OAPS,其中4例为轻度PE,5例为重度PE;3例胎死宫内,4例早产,2例足月产;5例行剖宫产术终止妊娠.3例行治疗性引产,1例阴道分娩.结论 APS合并SLE和不良孕产史时,PE发生风险更高;APS并发PE患者发生胎死宫内、早产和新生儿窒息的风险相对较高.对于难治性OAPS患者应评估其不良妊娠结局的风险因素,制定个体化的治疗策略.