目的 探讨全周期综合干预对风湿免疫性疾病患者妊娠结局的影响。方法 以2021-01至2022-05解放军总医院第七医学中心收治的51例妊娠合并风湿免疫性疾病患者作为研究组,采用本研究团队建立的全周期综合干预方法及诊治流程对研究组进行干预,同时选取2015-01至2020-12该单位收治的55例妊娠合并风湿免疫性疾病患者作为对照组,比较两组间妊娠结局的差异。结果 研究组子痫前期(5.89%)、胎儿生长受限(3.92%)、早产(15.69%)、原有疾病活动或加重(1.96%)的发生率明显低于对照组(分别为20.00%、16.36%、32.73%、12.73%,P均＜0.05)。对照组补体C3(0.80±0.15)、C4(0.11±0.03)水平明显低于研究组(分别为1.07±0.21、0.22±0.05,P均＜0.01),研究组免疫指标抗核抗体(35.29%)、抗SM抗体(9.80%)、抗dsDNA抗体(15.67%)、抗心磷脂抗体(23.53%)、抗β2 糖蛋白Ⅰ抗体(19.61%)、抗SSA 抗体(11.76%)、抗SSB 抗体(7.84%)阳性率明显低于对照组(分别为72.73%、27.27%、32.73%、41.82%、40%、27.27%、23.64%,P均＜0.05)。研究组选择剖宫产率(35.29%)明显高于对照组(18.18%,P<0.05),而总剖宫产率(41.18%)及产程剖宫产率(5.88%)明显低于对照组(分别为61.82%、43.64%,P<0.05)。研究组产后出血(3.92%)、胎膜早破(7.84%)、胎儿宫内窘迫(5.88%)、头盆不称(3.92%)的发生率均明显低于对照组(分别为16.36、23.64%、20.00%、18.18%,P<0.05)。研究组新生儿NICU入院(3.92%)、新生儿感染(9.80%)的发生率均明显低于对照组(分别为18.18%、27.27%,P<0.05)。结论 全周期综合干预方法能明显改善妊娠合并风湿免疫性疾病患者的母儿妊娠结局,降低剖宫产率。
Abstract
Objective To explore the effect of whole-cycle comprehensive intervention on pregnancy outcomes of patients with rheumatic immune diseases (RID). Methods A total of 51 pregnant women with RID admitted to the Seventh Medical Center of PLA General Hospital from January 2021 to May 2022 were selected as the study group, which was intervened with the whole-cycle comprehensive intervention methods and diagnosis and treatment process established by our research team. At the same time, 55 cases of pregnant women with RID admitted to the hospital from January 2015 to December 2020 were selected as the control group. The differences of pregnancy outcomes among the two groups were compared. Results The incidences of preeclampsia (5.89%), fetal growth restriction (3.92%), preterm delivery (15.69%), original disease activity or aggravation (1.96%) in the study group were significantly lower than those in the control group (20.00%, 16.36%, 32.73%, 12.73%, P<0.05). The levels of complement C3 (0.80±0.15) and C4 (0.11±0.03) in the control group were significantly lower than those in the study group (1.07±0.21, 0.22±0.05, P<0.01), and the positive rates of immune indicators antinuclear antibody (35.29%), anti SM antibody (9.80%), anti dsDNA antibody (15.67%), anti cardiolipin antibody (23.53%), anti β2 Glycoprotein I antibody (19.61%), anti SSA antibody (11.76%), anti SSB antibody (7.84%) in the study group were significantly lower than those in the control group (72.73%, 27.27%, 32.73%, 41.82%, 40%, 27.27%, 23.64%, P<0.05). The selective cesarean section rate (35.29%) in the study group were significantly higher than those in the control group (18.18%, P<0.05), while the total cesarean section rate (41.18%) and the cesarean section rate during labor (5.88%) were significantly lower than those in the control group (61.82%, 43.64%, P<0.05). The incidences of postpartum hemorrhage (3.92%), premature rupture of membranes (7.84%), fetal distress (5.88%) and cephalopelvic disproportion (3.92%) in the study group were significantly lower than those in the control group (16.36, 23.64%, 20.00%, 18.18%, P<0.05). The incidences of NICU admission (3.92%) and neonatal infection (9.80%) in the study group were significantly lower than those in the control group (18.18%, 27.27%, P<0.05). Conclusions The whole-cycle comprehensive intervention method can improve the maternal and fetal pregnancy outcomes and reduce the cesarean section rate.
关键词
风湿免疫性疾病 /
妊娠结局 /
综合干预方法 /
妊娠并发症
Key words
rheumatic immune diseases /
pregnancy outcome /
comprehensive intervention methods /
pregnancy complication
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