A Clinical Reseach Of40Cases Patients With New-onset Systemic Lupus Erythematosus During Pregnancy

Objective:To explore the clinical features such as disease onset age,duration, the initial symptoms, systems involvement and so on,as well aslaboratory test results,treatment and prognosis of the disease of40cases patientswith new-onset systemic lupus erythematosus during pregnancy,whohospitalized in our hospital recent decades,and summarize some experience soas to provide a reference for the clinical diagnosis and treatment of the disease.Methods: Retrospective analyzed the clinical material of40cases patientswith new-onset systemic lupus erythematosus during pregnancy,whomhospitalized in the first affiliated hospital of Guangxi Medical University duringJanuary2004to September2013.And60cases matched by age over the sameperiod in our hospital for treatment of non-pregnant SLE onset were randomlyselected as a control group,who were diagnosed in a period of more than12months without pregnancy.Divide the40patients with new-onset systemic lupuserythematosus during pregnancy into two subgroups by group A (patients withrenal involvement) and group B(patients without renal involvement) accordingto whether the patients with or without renal involvement.Recording the age at diagnosis,duration,the stages of pregnancy,gestational age at diagnosis,nulliparaor multipara, the initial symptoms, systems involvement, and general laboratorytest results, renal biopsy pathology,pregnancy outcome, as well as the treatmentand outcome of the disease.These were compared between cases andcontrols.Quantitative variables including disease onset age, disease activity,SLEDAI score were expressed as mean±SD. Dichotomous variables, such asthe stages of pregnancy, pregnancy outcome, and so on were showed as number(percentage). Independent t test was performed to compare the means ofcontinuous variable. Mann–Whitney U test was used, when normal distributionor equal variance could not be assumed. Chi-square test was performed tocompare categorical variables. P value of <0.05(two sides) was consideredsignificance.Results:1.There were altogether132cases SLE patients with pregnancyhospitalized in our hospital decades,of which40patients were first diagnosedwith SLE during pregnancy or postpartum,the proportion reaching30.1%.Theage of onsets of the40cases ranged from20to40,and the average was(26.4±4.2)years.Most new-onsets of SLE (85%) occurred in the first and secondtrimester.Pregnancy outcomes of the40patients was not optimistic, up to27.5%of the patients had abnormalities fetal, including six stillbirths, two cases of fetalmalformation, two inevitable abortions, one spontaneous abortion; theproportion of induced abortion was as high to47.5%.2.Duration of the disease varid among the individuals,but all in six monthsor less,and the shortest was three days;Which was shorter compared to thenon-pregnancy new-onsets.3.The initial symptoms of all patients were more common displayed with skin erythema, arthritis and/or arthralgia. However,compared with thenon-pregnant SLE new-onset patients,the pregnancy group patients were moreprone to facial and/or lower extremity edema.4.The literature found no statistically significant difference among the twogroups about amount of affected systems and the SLEDAI score reflectingdisease activity.Yet,patients with new-onset systemic lupus erythematosusduring pregnancy tended to be more prone to kidney damage,and had lowerfrequency of fever, fatigue,arthritis and arthralgia.5.Pregnant patients overall had a higher level of white blood cell count,buthad a lower levels of hemoglobin,serum albumin and immunoglobulin IgG,IgAand IgM.And the two groups showed no significant difference on complementlevels, erythrocyte sedimentation rate and CRP.6.Among the40cases of pregnancy patients,22patients (55%) appearedrenal involvement,of whom the percentage was higher than the controlgroup.However,their urinalysis had no statistically significant difference.Whilethe24-h urine protein excretion of pregnant patients was higher than theno-pregnant patients,thence when renal involvement new-onset SLE patientsduring pregnancy usually exhibited nephrotic syndrome as clinical types andwas seldomly seen as chronic nephritis.7.New-onset SLE patients during pregnancy with renal involvementcompared to these without renal involvement, had more systems involved,abigger lupus disease activity,and were more prone to severe anemia, also theESR was more high-up, complement C3was decreased more serious.8.The literature also found regardless of new-onset SLE patients duringpregnancy compared to no-pregnant new-onsets,or the new-onset pregrent SLEpatients with renal involvement compared to these without renal involvement,the autoantibody-positive rates and the titer of anti-ds-DNAantibody had no statistically significant difference.9.After treated with drugs,up to81.8%of onset SLE patients duringpregnancy can be improved, but it was still lower than the controlgroup,suggesting onset SLE patients during pregnancy with poor prognosis.Conclusion:1.New-onset SLE patients during pregnancy tended to occurred in the firstand second trimester.2.Adverse pregnancy outcomes of new-onset SLE patients duringpregnancy were more frequently happened.3.New-onset SLE patients during pregnancy are generally more prone torenal involvement,and when the kidney were involved, their renal diseaseusually with more clinical types of nephrotic syndrome appeared, but lesschronic nephritis.4.The majority patients with new-onset SLE during pregnancy could beimproved after treatment, but their prognosis was poorer,relatively.