病情控制良好的狼疮和抗磷脂综合…

病情控制良好的狼疮和抗磷脂综合征患者可做试管婴儿

作者：Bellver J, et al.
翻译：北医三院刘湘源(liu-xiangyuan@263.net)
发布：孙琳
审核：姚中强

目的：了解女性狼疮和抗磷脂综合征与不育间关系的证据，及促排卵和辅助生殖的相关风险，以使辅助生殖技术更为安全和成功。
设计：在MEDLINE上检索相关文献。
结果：除病情严重复发出现停经、肾功不全出现生殖能力降低，用环磷酰胺后出现卵巢衰竭外，其他狼疮和抗磷脂综合征患者与不育不孕无相关性。这些患者行促排卵治疗最危险的情况是狼疮复发和血栓形成，尤其是血栓形成与发生卵巢过度刺激综合征相关。最安全的方法是：适度的促排卵、移植单胚胎、避免卵巢过度刺激综合征、同时辅助治疗及用非口服天然雌二醇(雌酮、17β-雌二醇)或孕激素（黄体酮注射液，黄体酮胶囊/胶丸）。急性复发、未控制的高血压、进展性肾病、严重瓣膜或心脏病及血栓事件史的狼疮均不利于辅助生殖，尤其使孕期及围产期母婴合并症风险增高。
结论：病情控制良好的狼疮和抗磷脂综合征患者行促排卵辅助生殖是安全成功的。
附原文：AbstractOBJECTIVE:To review the currentevidence regarding the relationship between systemic lupus erythematosus (SLE)and antiphospholipid syndrome and female infertility, as well as the risksassociated with ovarian stimulation for ovulation induction and IVF. Toestablish, based on this information, guidelines for safe and successfulassisted reproductive technology (ART).DESIGN:A MEDLINE computer search wasperformed to identify relevant articles.RESULT(S):Systemic lupus erythematosus andantiphospholipid syndrome are not related to infertility, except for cases ofamenorrhea accompanying severe flares, renal insufficiency-relatedhypofertility, and ovarian failure secondary to cyclophosphamide (CTX) therapy.The most threatening conditions in affected women undergoing ovarianstimulation are lupus flares and thrombosis, with the latter being especiallyassociated with the occurrence of an overt ovarian hyperstimulation syndrome(OHSS). Friendly ovarian stimulation, single embryo transfer, avoidance ofOHSS, administration of coadjuvant therapy, and use of natural E(2) or Pthrough a nonoral route may constitute the safest approach. Systemic lupus manifestedin acute flares, badly controlled arterial hypertension, pulmonaryhypertension, advanced renal disease, severe valvulopathy or heart disease, andmajor previous thrombotic events are situations on which to discourage ART,especially due to the high risk of complications for both mother and fetusduring pregnancy and puerperium. CONCLUSION(S):Ovarian stimulation forovulation induction and IVF seems to be safe and successful inwell-selected women with SLE and antiphospholipid syndrome.
引自：Bellver J, Pellicer A.Ovarianstimulation for ovulation induction and in vitro fertilization in patients withsystemic lupus erythematosus and antiphospholipid syndrome.Fertil Steril，2009，92(6):1803-10.



译者介绍：刘湘源

刘湘源，男，医学博士，教授，主任医师，博士生导师。现任北京大学第三医院风湿免疫科主任、北京大学医学部风湿免疫学系副主任。中国医师协会风湿免疫定期考核委员会主任委员。主要致力于类风湿关节炎发病机制和治疗的研究。先后负责多项国家级基金项目研究。发表学术论文100余篇，主编《表格式临床医学系列丛书.风湿病分册》、《风湿性疾病病案分析》和《关节炎-诊断和治疗学》等多部专著。