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목적 : 전신성 홍반성 루푸스는 가임기 여성에서 주 로 발생하는 자가면역질환이다. 임신은 호르몬과 면역계 에 변화를 일으켜 루푸스와 상호 작용하는 것으로 생각 되어지고 있다. 국내 환자를 대상으로 임신이 루푸스의 경과에 미치는 영향과 루푸스가 임신의 경과에 미치는 영향을 분석하고, 임신과 태아의 예후에 영향을 주는 임 상적, 혈청학적 요인을 알아보고자 하였다. 방법 : 서울 아산 병원에서 루푸스로 진단 받은 환자 중 임신을 경험한 47명, 49예의 임신에 대한 의무기록 검토를 통해 임상 경과와 검사 소견, 투약 상태를 후향 적으로 조사하고 분석하였다. 결과 : 임신 중 루푸스의 증상 악화는 30예(61.2%)에 서 나타났다. 루푸스의 악화를 경험한 시기는 임신 2기 에 13예(26.4%)로 가장 많았고, 임상 증상 악화시 나타 낸 증상, 증후로는 피부증상이 13예(43.3%), 근 골격계 증상이 8예(26.7%)였고, 단백뇨, 미세혈뇨 등의 신장 침 범 증후와 발열이 각 6예(20.0%), 혈액학적 이상이 5예 (16.7%), 장막염이 2예(6.7%), 임파선 종대가 1예(3.3%) 였다. 임신 시 루푸스의 악화에 유의하게 영향을 주는 인자는 없었다. 22예(44.9%)에서 정상적으로 만삭아를 출산하였고, 10예(20.4%)에서 조산, 5예(10.2%)에서 자 궁내 발육지연을 나타내었다. 12예의 태아사망 중 자연 유산, 치료적 유산이 각각 5예(10.2%)였고, 사산이 2예 (4.1%)였다. 단변량분석에서 항인지질 항체, 신장염, 수 태시 활동성 루푸스, 임신 중 루푸스의 악화 등이 임신 성적에 영향을 주는 요인이었으나, 다변량 분석에서는 항인지질 항체와 임신 중 루푸스 악화만이 유의한 영향 을 주는 것으로 타났다. 항인지질 항체 양성 환자에서 태아 사망이 의미있게 증가하였으며, 임신 중 루푸스 증 상의 악화를 경험한 경우 조산이나 자궁내 성장지체가 증가하였다. - 신정현 외 6인 : 전신성 홍반성 루푸스와 임신의 상호 영향에 대한 연구 - - 519 -


Background : Our aim was to assess the rate of flare in patients with systemic lupus erythematosus (SLE) during pregnancy, to describe fetal outcomes in lupus in Asan Medical Center and to identify clinical or serological factors that would predict pregnancy loss and poor fetal outcome. Methods : We retrospectively studied 49 pregnancies in 47 women with SLE. Clinical and laboratory data were identified from medical record. Results : Lupus flare occurred in 30 (61.2%) of the pregnancies, mostly in the second trimester. Flares presented most commonly as involvement of skin or joints, constitutional symptoms. All of the patients with flare were treated with glucocorticosteroid. There was no predictive factor for flare of lupus during pregnancy. There were 37 (75.5%) live births and 12 (24.5%) fetal losses. Of live births, 10 (20.4%) were premature babies, 5 (10.2%) intrauterine growth retardation. Of fetal losses, 5 (10.2%) were spontaneous abortion, 5 (10.2%) therapeutic abortion, 2 (4.1%) still births. Using univariate analysis, predictive factors for adverse fetal outcome include antiphospholipid antibody, renal involvement, active lupus at conception and flare of lupus during pregnancy. Using multivariate analysis, antiphospholipid antibody was the only significant predictor for fetal loss, and lupus flare during pregnancy was the only significant predictor for poor fetal outcome. Conclusion : There was no predictive factor for the flare of lupus during pregnancy. Most lupus pregnancies did well, but there was a higher rate of adverse fetal outcome. Antiphospholipid antibody and flare of lupus during pregnancy were the only important predictors of fetal loss and premature birth, respectively.(Korean J Med 65:511-519, 2003)


Background : Our aim was to assess the rate of flare in patients with systemic lupus erythematosus (SLE) during pregnancy, to describe fetal outcomes in lupus in Asan Medical Center and to identify clinical or serological factors that would predict pregnancy loss and poor fetal outcome. Methods : We retrospectively studied 49 pregnancies in 47 women with SLE. Clinical and laboratory data were identified from medical record. Results : Lupus flare occurred in 30 (61.2%) of the pregnancies, mostly in the second trimester. Flares presented most commonly as involvement of skin or joints, constitutional symptoms. All of the patients with flare were treated with glucocorticosteroid. There was no predictive factor for flare of lupus during pregnancy. There were 37 (75.5%) live births and 12 (24.5%) fetal losses. Of live births, 10 (20.4%) were premature babies, 5 (10.2%) intrauterine growth retardation. Of fetal losses, 5 (10.2%) were spontaneous abortion, 5 (10.2%) therapeutic abortion, 2 (4.1%) still births. Using univariate analysis, predictive factors for adverse fetal outcome include antiphospholipid antibody, renal involvement, active lupus at conception and flare of lupus during pregnancy. Using multivariate analysis, antiphospholipid antibody was the only significant predictor for fetal loss, and lupus flare during pregnancy was the only significant predictor for poor fetal outcome. Conclusion : There was no predictive factor for the flare of lupus during pregnancy. Most lupus pregnancies did well, but there was a higher rate of adverse fetal outcome. Antiphospholipid antibody and flare of lupus during pregnancy were the only important predictors of fetal loss and premature birth, respectively.(Korean J Med 65:511-519, 2003)