摘 要
背景：狼瘡患者在考慮妊娠時腎臟疾病是一個很值得關注的問題。此研究旨在分析既往存在狼瘡腎炎、尤其是存在抗dsDNA抗體陽性且有低補體患者在妊娠期腎臟病復發的概率，以及對於狼瘡疾病相對穩定或中度活動的患者妊娠期新發狼瘡腎臟疾病的危險性。
方法：主要評估活動性腎炎（腎炎復發以及新發生的腎臟疾病）以及孕期尿蛋白≤1000mg、血肌酐＜1.2mg/dl的狼瘡患者。2003年至2012年間的共373例患者納入研究，並對妊娠結局的指標進行前瞻性研究。活動性腎炎定義為蛋白尿增加＞500mg和/或出現紅細胞管型。
結果：在既往存在腎臟疾病的118例患者中，13例出現腎臟疾病復發（89例完全緩解的患者中有7例出現復發，29例部分緩解的患者中有6例出現復發）而在255例既往無腎臟疾病患者中，僅4例患者出現新發腎臟疾病，兩組之間P＜0.001。腎炎活動與種族、年齡、血肌酐、血壓以及抗高血壓以及其他藥物之間不相關。在多因素回歸分析中，既往存在腎臟疾病的完全緩解或部分緩解的患者相比既往無腎臟疾病的患者，更容易出現腎臟疾病的再次活動。低補體C4與腎臟疾病復發有關係，但低補體C3或抗dsDNA抗體陽性與腎臟疾病復發無關。
結論：在妊娠期，狼瘡患者新發腎臟疾病是不常見的。既往存在腎臟疾病以及低補體C4是妊娠期腎臟疾病活動復發的獨立危險因素。對於既往存在腎臟疾病且處於緩解期，僅抗dsDNA抗體的陽性可不必擔心妊娠期出現腎臟疾病的活動。
Abstract
Background andobjectives Kidney disease is a critical concern in counseling patients withlupus considering pregnancy. This study sought to assess the risk of renalflares during pregnancy in women with previous lupus nephritis inpartial orcomplete remission,particularly in those with antidouble-stranded DNA antibodiesand low complement levels, and the risk of new-onset nephritis in patients withstable/mildly active SLE.
Design, setting,participants,&measurements Weassessedactive nephritis (renal flares and de novo kidney disease) and associatedpredictors during pregnancy in patients with lupus with urine protein #1000 mgand serum creatinine ,1.2 mg/dl at baseline; 373 patients (52% ethnic/racialminorities) enrolled between 2003 and 2012 were prospectively followed in thePredictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome andSystemic Lupus Erythematosus Study. Active nephritis was defined by proteinuriaincrease of .500 mg and/or red blood cell casts.
Results Of 118 patients withprevious kidney disease, 13 renal flares (11%) occurred (seven of 89 incomplete remission and six of 29 in partial remission) compared with four withde novo kidney involvement (2%) in 255 patients without past kidney disease(P,0.001). Active nephritis was not associated with ethnicity, race, age, creatinine,BP, or antihypertensive and other medications. In multivariable logisticregression analyses, patients with past kidney disease in complete or partialremission more often experienced active nephritis (adjusted odds ratio, 6.88;95%confidence interval, 1.84 to 25.71; P=0.004 and adjusted odds ratio, 20.98;95%confidence interval, 4.69 to 93.98; P,0.001, respectively) than thosewithout past kidney disease. Low C4 was associated with renal flares/de novodisease (adjusted odds ratio, 5.59; 95% confidence interval, 1.64 to 19.13;P,0.01) but not low C3 or positive anti-dsDNA alone.
Conclusions De novo kidneyinvolvement in SLE, even in ethnic/racial minorities, is uncommon duringpregnancy. Past kidney disease and low C4 at baseline independently associatewith higher risk of developing active nephritis. Antibodies to dsDNA aloneshould not raise concern, even in patients with past kidney disease, if inremission.
引自：Jill P. Buyon, Mimi Y. Kim,Marta M. Guerra,Kidney Outcomes and Risk Factors for Nephritis (Flare/DeNovo) in a Multiethnic Cohort of Pregnant Patients with Lupus Clin J Am Soc Nephrol 12:940–946, 2017.
來源：中國風溼病公眾論壇
翻譯：北醫三院風溼科李欣藝