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中华产科急救电子杂志 ›› 2019, Vol. 08 ›› Issue (02) : 97 -102. doi: 10.3877/cma.j.issn.2095-3259.2019.02.008

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妊娠合并未分化结缔组织病的管理
陈乐锋1, 戴冽1,()   
  1. 1. 510120 广州,中山大学孙逸仙纪念医院风湿免疫科
  • 收稿日期:2019-01-21 出版日期:2019-05-18
  • 通信作者: 戴冽

Management of pregnancy complicated with undifferentiated connective tissue disease

Lefeng Chen1, Lie Dai1()   

  • Received:2019-01-21 Published:2019-05-18
  • Corresponding author: Lie Dai
引用本文:

陈乐锋, 戴冽. 妊娠合并未分化结缔组织病的管理[J/OL]. 中华产科急救电子杂志, 2019, 08(02): 97-102.

Lefeng Chen, Lie Dai. Management of pregnancy complicated with undifferentiated connective tissue disease[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(02): 97-102.

妊娠合并未分化结缔组织病是育龄期女性最常见的风湿病之一,合并妊娠可导致未分化结缔组织病病情复发、加重,甚至出现严重并发症,增加发生妊娠不良事件的风险。因此,需要风湿科和产科医生早期识别、共同管理,通过严密监测和合理用药来保障母胎安全。

Undifferentiated connective tissue disease (UCTD) during pregnancy is one of the most common rheumatic diseases in women of childbearing age. Pregnancy can lead to recurrence, aggravation, and even serious complications of undifferentiated connective tissue disease, increasing the risk of adverse pregnancy events. Therefore, it is necessary for the rheumatologists and obstetricians to identify pregnant women with UCTD early and management it together, and to ensure the safety of the mother and fetus through strict monitoring and rational use of drugs.

[1]
中国系统性红斑狼疮研究协作组专家组,国家风湿病数据中心. 中国系统性红斑狼疮患者围产期管理建议[J]. 中华医学杂志,2015, 95(14): 1056-1060.
[2]
Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women′s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome [J]. Ann Rheum Dis, 2017, 76(3): 476-485.
[3]
Götestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation [J]. Ann Rheum Dis, 2016, 75(5): 795-810.
[4]
Flint J, Panchal S, Hurrell A, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids [J]. Rheumatology (Oxford), 2016, 55(9): 1693-1697.
[5]
Flint J, Panchal S, Hurrell A, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice [J]. Rheumatology (Oxford), 2016, 55(9): 1698-1702.
[6]
Mosca M, Tani C, Talarico R, et al. Undifferentiated connective tissue diseases (UCTD): simplified systemic autoimmune diseases [J]. Autoimmun Rev, 2011, 10(5): 256-258.
[7]
Alarcón GS, Williams GV, Singer JZ, et al. Early undifferentiated connective tissue disease. I. Early clinical manifestation in a large cohort of patients with undifferentiated connective tissue diseases compared with cohorts of well established connective tissue disease [J]. J Rheumatol, 1991, 18(9): 1332-1329.
[8]
Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases [J]. Arthritis Res Ther, 2009, 11(3): 229.
[9]
Shapira Y, Agmon-Levin N, Shoenfeld Y. Geoepidemiology of autoimmune rheumatic diseases [J]. Nat Rev Rheumatol, 2010, 6(8): 468-476.
[10]
Spinillo A, Beneventi F, Epis OM, et al. Prevalence of undiagnosed autoimmune rheumatic diseases in the first trimester of pregnancy. Results of a two-steps strategy using a self-administered questionnaire and autoantibody testing [J]. BJOG, 2008, 115(1): 51-57.
[11]
Mosca M, Neri R, Bombardieri S. Undifferentiated connective tissue diseases (UCTD): a review of the literature and a proposal for preliminary classification criteria [J]. Clin Exp Rheumatol, 1999, 17(5): 615-620.
[12]
Mosca M, Tani C, Neri C, et al. Undifferentiated connective tissue diseases (UCTD) [J]. Autoimmun Rev, 2006, 6(1): 1-4.
[13]
Mosca M, Tani C, Vagnani S, et al. The diagnosis and classification of undifferentiated connective tissue diseases [J]. J Autoimmun, 2014, 48-49: 50-52.
[14]
Vaz CC, Couto M, Medeiros D, et al. Undifferentiated connective tissue disease: a seven-center cross-sectional study of 184 patients [J]. Clin Rheumatol, 2009, 28(8): 915-921.
[15]
Mosca M, Tani C, Bombardieri S. Defining undifferentiated connective tissue diseases: a challenge for rheumatologists [J]. Lupus, 2008, 17(4): 278-280.
[16]
Doria A, Mosca M, Gambari PF, et al. Defining unclassifiable connective tissue diseases: incomplete, undifferentiated, or both? [J]. J Rheumatol, 2005, 32(2): 213-215.
[17]
吕良敬,倪若柠. 重视复发性流产患者中未分化结缔组织病的诊断[J]. 诊断学理论与实践,2018, 17(3): 235-237.
[18]
Castellino G, Capucci R, Bernardi S, et al. Pregnancy in patients with undifferentiated connective tissue disease: a prospective case-control study [J]. Lupus, 2011, 20(12):1305-1311.
[19]
Spinillo A, Beneventi F, Epis OM, et al. The effect of newly diagnosed undifferentiated connective tissue disease on pregnancy outcome [J]. Am J Obstet Gynecol, 2008, 199(6): 632.e1-632.e6.
[20]
Spinillo A, Beneventi F, Caporali R, et al. Undifferentiated connective tissue diseases and adverse pregnancy outcomes. An undervalued association? [J]. Am J Reprod Immunol, 2017, 78(6).
[21]
Spinillo A, Beneventi F, Locatelli E, et al. The impact of unrecognized autoimmune rheumatic diseases on the incidence of preeclampsia and fetal growth restriction: a longitudinal cohort study [J]. BMC Pregnancy Childbirth, 2016, 16(1): 313.
[22]
Alexander E, Buyon JP, Provost TT, et al. Anti-Ro/SS-A antibodies in the pathophysiology of congenital heart block in neonatal lupus syndrome, an experimental model. In vitro electrophysiologic and immunocytochemical studies [J]. Arthritis Rheum, 1992, 35: 176-189.
[23]
Miranda-Carús ME, Askanase AD, Clancy RM, et al. Anti-SSA/Ro and anti-SSB/La autoantibodies bind the surface of apoptotic fetal cardiocytes and promote secretion of TNF-alpha by macrophages [J]. J Immunol, 2000, 165: 5345-5351.
[24]
Xiao GQ, Hu K, Boutjdir M. Direct inhibition of expressed cardiac l- and t-type calcium channels by igg from mothers whose children have congenital heart block [J]. Circulation, 2001, 103(11): 1599-1604.
[25]
Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study [J]. Circulation, 2008, 117(4): 485-493.
[26]
Ambrosi A, Wahren-Herlenius M. Congenital heart block: evidence for a pathogenic role of maternal autoantibodies [J]. Arthritis Res Ther, 2012, 14(2): 208.
[27]
Liberman L, Pass RH, Hordof AJ, et al. Late onset of heart block after open heart surgery for congenital heart disease [J]. Pediatr Cardiol, 2008, 29(1): 56-59.
[28]
Lotfy W, Hegazy R, AbdElAziz O, et al. Permanent cardiac pacing in pediatric patients [J]. Pediatr Cardiol, 2013, 34(2): 273-280.
[29]
Damoiseaux J, von Mühlen CA, Garcia-De La Torre I, et al. International consensus on ANA patterns (ICAP): the bumpy road towards a consensus on reporting ANA results [J]. Auto Immun Highlights, 2016, 7(1): 1.
[30]
中国医师协会风湿免疫科医师分会自身抗体检测专业委员会. 抗核抗体检测的临床应用专家共识[J]. 中华检验医学杂志,2018, 41(4): 275-280.
[31]
Elnady BM, Kamal NM, Shaker RH, et al. Prevalence and clinical significance of nonorgan specific antibodies in patients with autoimmune thyroiditis as predictor markers for rheumatic diseases [J]. Medicine (Baltimore), 2016, 95(38): e4336.
[32]
Beneventi F, Locatelli E, Caporali R, et al. Connective tissue diseases and autoimmune thyroid disorders in the first trimester of pregnancy [J]. J Reprod Immunol, 2016, 114: 32-37.
[33]
Kumru P, Erdogdu E, Arisoy R, et al. Effect of thyroid dysfunction and autoimmunity on pregnancy outcomes in low risk population [J]. Arch Gynecol Obstet, 2015, 291(5): 1047-1054.
[34]
Izmirly PM, Costedoat-Chalumeau N, Pisoni CN, et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus [J]. Circulation, 2012, 126(1): 76-82.
[35]
Ruiz-Irastorza G, Khamashta MA. Lupus and pregnancy: integrating clues from the bench and bedside [J]. Eur J Clin Invest, 2011, 41(6): 672-678.
[36]
Knight CL, Nelson-Piercy C. Management of systemic lupus erythematosus during pregnancy: challenges and solutions [J]. Open Access Rheumatol, 2017, 9: 37-53.
[37]
Singh AG, Chowdhary VR. Pregnancy-related issues in women with systemic lupus erythematosus [J]. Int J Rheum Dis, 2015, 18(2): 172-181.
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