女性狼疮和抗磷脂综合征患者孕育…

女性狼疮和抗磷脂综合征患者孕育和辅助生殖的EULAR建议

作者：Andreoli L, 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：对女性狼疮和(或)抗磷脂综合征患者的健康问题和生育计划提出建议。
方法：系统复习相关证据，然后采取Delphi方法汇集问题，引出专家建议，并达成共识。
结果： 女性狼疮和抗磷脂综合征患者诊断后应尽早关注生育问题，多数患者可成功怀孕，并采取措施降低母婴不良结局的风险。危险分层包括疾病活动度、自身抗体谱、血管病和妊娠相关疾病病史、高血压和药物使用情况（重点是羟氯喹和抗血小板/抗凝药物获益）。对于不活动的稳定期和血栓低风险患者，可用性激素避孕药和停经替代疗法。在用烷化剂（环磷酰胺）类药时，可同时用促性腺激素释放激素类似物保持生育力。对于不活动的稳定期患者，可行辅助生殖。抗磷脂抗体阳性或抗磷脂综合征患者应抗凝和（或）低剂量阿司匹林治疗。评估疾病活动度、肾功能和血清标记物对判断疾病复发和监控产科不良结局很重要。胎儿监测包括多普勒超声和胎儿生物测量, 尤其是孕晚期，需筛查胎盘功能不全和了解胎儿是否小于孕周数。产科肿瘤筛查与一般人群相似，如果用免疫抑制剂，则发生宫颈癌前病变的可能性增高。在不活动的稳定期患者，应接种HPV病毒疫苗。
结论：基于循证医学证据，达成专家共识，提出了女性狼疮和（或）抗磷脂综合征患者的健康建议。

附原文：
Abstract OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupusery thematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidencefollowed by modified Delphi method to compile questions, elicit expert opinionsand reach consensus. RESULTS: Familyplanning should be discussed as early as possible after diagnosis. Most womencan have successful pregnancies and measures can be taken to reduce the risksof adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine andantiplatelets /anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable /inactive disease andlow risk of thrombosis. Fertility preservation with gonadotropin-releasinghormone analogues should be considered prior to the use of alkylating agents.Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS shouldreceive anticoagulation and/or low-dose aspirin. Assessment of disease activity,renal function and serological markers is important for diagnosing disease flares and monitoring for obstetricaladverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetalbiometry, particularly in the third trimester, to screen for placentalinsufficiency and small for gestational age fetuses. Screening forgynaecological malignancies is similar to the general population, withincreased vigilance for cervical premalignant lesions if exposed toimmunosuppressive drugs. Human papillomavirus immunisation can be used in womenwith stable/inactive disease. CONCLUSIONS: Recommendations for women's health issues in SLE and/or APS were developed using an evidence-basedapproach followed by expert consensus.

引自：
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. Ann Rheum Dis, 2016 Jul 25. pii:annrheumdis-2016-209770. doi: 10.1136/annrheumdis-2016-209770. [Epub ahead ofprint]