山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (8): 38-43.doi: 10.6040/j.issn.1671-7554.0.2021.0935
国云飞,舒强
GUO Yunfei, SHU Qiang
摘要： 复发性流产(RSA)的主要病因之一为合并风湿免疫病。近年来,免疫抑制剂在RSA合并风湿免疫病患者的治疗方案中逐渐占据主要地位,其治疗效果也普遍得到认可。由于RSA合并风湿免疫病涉及到多个学科领域,目前对于免疫抑制剂的适应证及用法用量亟待进一步规范。论文结合近年的临床指南和科学研究进展,从RSA定义、风湿病与RSA相关性、免疫抑制剂的使用等方面,对国内外现有文献进行述评,提高读者对于相关疾病及药物的认识,为临床医师在实践中做出合理决策提供参考。
中图分类号:
| [1] Eudy AM, Siega-Riz AM, Engel SM, et al. Effect of pregnancy on disease flares in patients with systemic lupus erythematosus[J]. Ann Rheum Dis, 2018, 77(6): 855-860. [2] Sugawara E, Kato M, Fujieda Y, et al. Pregnancy outcomes in women with rheumatic diseases: a real-world observational study in Japan[J]. Lupus, 2019, 28(12): 1407-1416. [3] 复发性流产合并风湿免疫病免疫抑制剂应用中国专家共识编写组. 复发性流产合并风湿免疫病免疫抑制剂应用中国专家共识[J]. 中华生殖与避孕杂志, 2020, 40(7): 527-534. [4] 自然流产诊治中国专家共识编写组.自然流产诊治中国专家共识(2020年版)[J]. 中国实用妇科与产科杂志, 2020, 36(11): 1082-1090. [5] Chen Y, Wu Q, Wei J, et al. Effects of aspirin, vitamin D3, and progesterone on pregnancy outcomes in an autoimmune recurrent spontaneous abortion model[J]. Braz J Med Biol Res, 2021, 54(9): e9570. doi: 10.1590/1414-431X2020e9570. [6] Ceccarelli F, Pirone C, Perricone C, et al. Pregnancy outcome in systemic lupus erythematosus patients: a monocentric cohort analysis[J]. Rheumatology(Oxford), 2021, 60(4): 1747-1754. [7] Hiramatsu Y, Isoda K, Kotani T, et al. Pre-pregnancy serum complement C3 level is a predictor of preterm birth for pregnancies with systemic lupus erythematosus[J]. Arthritis Res Ther, 2021, 23(1): 140. doi: 10.1186/s13075-021-02522-x. [8] Zhang S, Wu Z, Zhang W, et al. Clinical performance of non-criteria antibodies to phospholipids in Chinese patients with antiphospholipid syndrome[J]. Clin Chim Acta, 2019, 495: 205-209. doi: 10.1016/j.cca.2019.04.065. [9] Nalli C, Lini D, Andreoli L, et al. Low preconception complement levels are associated with adverse pregnancy outcomes in a multicenter study of 260 pregnancies in 197 women with antiphospholipid syndrome or carriers of antiphospholipid antibodies[J]. Biomedicines, 2021, 9(6): 671. doi: 10.3390/biomedicines9060671. [10] Cohen H, Efthymiou M, Devreese KMJ. Monitoring of anticoagulation in thrombotic antiphospholipid syndrome[J]. J Thromb Haemost, 2021, 19(4): 892-908. [11] Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American college of rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases[J]. Arthritis Rheumatol, 2020, 72(4): 529-556. [12] Bröms G, Kieler H, Ekbom A, et al. Anti-TNF treatment during pregnancy and birth outcomes: a population-based study from Denmark, Finland, and Sweden[J]. Pharmacoepidemiol Drug Saf, 2020, 29(3): 316-327. [13] Elliott B, Spence AR, Czuzoj-Shulman N, et al. Effect of Sjögrens syndrome on maternal and neonatal outcomes of pregnancy[J]. J Perinat Med, 2019, 47(6): 637-642. [14] Spinillo A, Beneventi F, Ramoni V, et al. Prevalence and significance of previously undiagnosed rheumatic diseases in pregnancy[J]. Annals of the Rheumatic Diseases, 2012, 71(6): 918-923. [15] Zucchi D, Tani C, Monacci F, et al. Pregnancy and undifferentiated connective tissue disease: outcome and risk of flare in 100 pregnancies[J]. Rheumatology(Oxford), 2020, 59(6): 1335-1339. [16] de Moreuil C, Alavi Z, Pasquier E. Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage[J]. Br J Clin Pharmacol, 2020, 86(1): 39-49. [17] Duan J, Ma D, Wen X, et al. Hydroxychloroquine prophylaxis for preeclampsia, hypertension and prematurity in pregnant patients with systemic lupus erythematosus: a meta-analysis[J]. Lupus, 2021, 30(7): 1163-1174. [18] Yang S, Ni R, Lu Y, et al. A three-arm, multicenter, open-label randomized controlled trial of hydroxychloroquine and low-dose prednisone to treat recurrent pregnancy loss in women with undifferentiated connective tissue diseases: protocol for the Immunosuppressant regimens for LIving FEtuses(ILIFE)trial[J]. Trials, 2020, 21(1): 771. doi: 10.1186/s13063-020-04716-1. [19] Dong Y, Lu Y, Xia Y, et al. Effect of hydroxychloroquine on antiphospholipid antibodies-inhibited endometrial angiogenesis[J]. J Matern Fetal Neonatal Med, 2021: 1-9. doi: 10.1080/14767058.2021.1943656. [20] Ou H, Yu Q. Efficacy of aspirin, prednisone, and multivitamin triple therapy in treating unexplained recurrent spontaneous abortion: a cohort study[J]. Int J Gynaecol Obstet, 2020, 148(1): 21-26. [21] Ince-Askan H, van den Akker ELT, de Rijke YB, et al. Associations between antenatal prednisone exposure and long-term cortisol and cortisone concentrations in children born to women with rheumatoid arthritis: results from a nationwide prospective cohort study[J]. RMD Open, 2019, 5(1): e000852. doi: 10.1136/rmdopen-2018-000852. [22] De Cock D, Brants L, Soenen I, et al. A systematic review on the effect of DMARDs on fertility in rheumatoid arthritis[J]. Semin Arthritis Rheum, 2020, 50(5): 873-878. [23] Huang W, Lu W, Li Q, et al. Effects of cyclosporine A on proliferation, invasion and migration of HTR-8/SVneo human extravillous trophoblasts[J]. Biochem Biophys Res Commun, 2020, 533(4): 645-650. [24] Sharma UR, Rathnakaran AN, Raj BPP, et al. The positive effect of pregnancy in rheumatoid arthritis and the use of medications for the management of rheumatoid arthritis during pregnancy[J]. Inflammopharmacology, 2021, 29(4): 987-1000. [25] Balbi GGM, Domingues V, Balbi GGM, et al. Use of synthetic and biologic DMARDs during pregnancy[J]. Expert Rev Clin Immunol, 2019, 15(1): 27-39. [26] Ponticelli C, Moroni G. Fetal toxicity of immunosuppressive drugs in pregnancy[J]. J Clin Med, 2018, 7(12): 552. doi: 10.3390/jcm7120552. [27] Yang X, Meng T. Is there a role of intravenous immunoglobulin in immunologic recurrent pregnancy loss?[J]. J Immunol Res, 2020, 2020: 6672865. doi: 10.1155/2020/6672865. [28] Urban ML, Bettiol A, Serena C, et al. Intravenous immunoglobulin for the secondary prevention of stillbirth in obstetric antiphospholipid syndrome: a case series and systematic review of literature[J]. Autoimmun Rev, 2020, 19(9): 102620. doi: 10.1016/j.autrev.2020.102620. [29] Prieto-Peña D, Calderón-Goercke M, Adán A, et al. Efficacy and safety of certolizumab pegol in pregnant women with uveitis. Recommendations on the management with immunosuppressive and biologic therapies in uveitis during pregnancy[J]. Clin Exp Rheumatol, 2021, 39(1): 105-114. [30] Perrotta K, Kiernan E, Bandoli G, et al. Pregnancy outcomes following maternal treatment with rituximab prior to or during pregnancy: a case series[J]. Rheumatol Adv Pract, 2021, 5(1): rkaa074. doi: 10.1093/rap/rkaa074. [31] Saito J, Yakuwa N, Kaneko K, et al. Tocilizumab during pregnancy and lactation: drug levels in maternal serum, cord blood, breast milk and infant serum[J]. Rheumatology(Oxford), 2019, 58(8): 1505-1507. [32] Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus[J]. Ann Rheum Dis, 2019, 78(6): 736-745. [33] Akhlaghi M, Kianersi F, Radmehr H, et al. Evaluation of optical coherence tomography angiography parameters in patients treated with Hydroxychloroquine[J]. BMC Ophthalmol, 2021, 21(1): 209. doi: 10.1186/s12886-021-01977-5. |
| [1] | 成晅,杨帆,潘正论. 系统性红斑狼疮、抗磷脂抗体综合征伴颅内静脉窦血栓形成1例并文献复习[J]. 山东大学学报 (医学版), 2022, 60(6): 70-74. |
| [2] | 杨岫岩,张建瑜. 从风湿免疫角度谈生殖免疫的一些思路[J]. 山东大学学报 (医学版), 2021, 59(8): 20-23. |
| [3] | 赵冰清,高选,李江夏. 基于辅助生殖人群的复发性流产夫妇染色体核型回顾性分析[J]. 山东大学学报 (医学版), 2021, 59(7): 26-31. |
| [4] | 王百惠,宋艳君,张帅庆,左秀丽,王青,张爱军,李如源. 以腹泻为首发症状的淀粉样变3例及文献复习[J]. 山东大学学报 (医学版), 2020, 58(5): 93-97. |
| [5] | 冯洒然,刘倩,王焱,李红,毕可红,朱传升. 系统性红斑狼疮伴发肝脾γδT细胞淋巴瘤1例并文献复习[J]. 山东大学学报 (医学版), 2018, 56(6): 87-90. |
| [6] | 张好. 系统性红斑狼疮合并狼疮脑病、重症自身免疫性胰腺炎1例[J]. 山东大学学报 (医学版), 2018, 56(2): 93-94. |
| [7] | 曲晓霞. 有汗性外胚叶发育不良合并系统性红斑狼疮1例[J]. 山东大学学报 (医学版), 2018, 56(2): 95-96. |
| [8] | 杜金阁,陈慧,杨孝荣,吕明. STAT4 rs7574865位点单核苷酸多态性与系统性红斑狼疮易感性Meta分析[J]. 山东大学学报（医学版）, 2017, 55(5): 95-102. |
| [9] | 徐大霞,侯楠,李晓峰,王闯,孔猛,焦广俊,陈允震. 糖皮质激素性骨质疏松症骨代谢与糖皮质激素用药时间的相关性[J]. 山东大学学报（医学版）, 2017, 55(5): 103-107. |
| [10] | 麻贞贞,孙红胜,杨清锐. 脂联素、内脂素、抵抗素在系统性红斑狼疮患者血清中的变化及临床意义[J]. 山东大学学报（医学版）, 2017, 55(4): 86-90. |
| [11] | 李健,徐冰,闫新峰,徐万菊,常晓天. 筛选TXNDC5与胰岛素相关信号通路关键基因的探讨[J]. 山东大学学报（医学版）, 2017, 55(3): 88-93. |
| [12] | 赵琰,郑亚冰,闫新峰,张虎,常晓天. 筛选类风湿关节炎中糖代谢关键基因的探讨[J]. 山东大学学报（医学版）, 2016, 54(3): 30-35. |
| [13] | 姜慧钰, 王林, 潘继红. siRNA沉默PCSK6基因对胶原诱导性关节炎的影响[J]. 山东大学学报（医学版）, 2015, 53(12): 20-26. |
| [14] | 潘娟, 胡慧. 系统性红斑狼疮合并2型糖尿病1例个案管理报道[J]. 山东大学学报（医学版）, 2014, 52(S2): 64-65. |
| [15] | 郑加田，朱凯，孙红胜，付敏，潘正论. IL-18和MCP-1基因多态性与类风湿关节炎易感性关系的Meta分析[J]. 山东大学学报（医学版）, 2014, 52(6): 98-104. |
|
