羟氯喹治疗妊娠合并结缔组织疾病的227例临床分析

A clinical study of 227cases of pregnancy complicated with connective tissue diseases treated by hydroxychloroquine

摘要:

目的： 研究羟氯喹（hydroxychloroquine，HCQ）治疗能否改善结缔组织疾病（connective tissue disease，CTD）患者的妊娠结局。方法： 本研究为多中心回顾性队列研究，收集重庆医科大学医渡云数据库中（纳入6家医院）近10年（2010年1月1日至2020年10月30日）妊娠合并CTD的病例。最终纳入227例CTD患者，根据这些患者在妊娠前6个月或妊娠期间是否开始HCQ治疗分为2组：HCQ治疗组（108例）和HCQ对照组（119例）。结果： HCQ治疗组发生妊娠期高血压（5.0% vs.17.6%，P=0.003）、早产（19.3% vs. 25.0%，P=0.303）和低出生体质量儿（20.0% vs. 45.0%，P<0.001）的风险较对照组明显降低。进一步多元回归分析发现，HCQ是妊娠期高血压（OR=0.31，95%CI=0.10~0.93，P=0.037）、早产（OR=0.28，95%CI=0.10~0.79，P=0.016）和低出生体质量儿（OR=0.31，95%CI=0.13~0.72，P=0.006）的独立保护因素。结论： HCQ能有效改善CTD患者的妊娠结局，尤其是降低妊娠期高血压、早产和低出生体质量儿发生的风险。

Abstract:

Objective: To examine the effects of hydroxychloroquine（HCQ） treatment on pregnancy outcomes in women with connective tissue disease（CTD）. Methods: We conducted a retrospective cohort study of pregnant women with CTD in 6 hospitals in recent 10 years（from January 1，2010 to October 30，2020），taking the medical records of Chongqing Medical University Medical Data Scinece Acadmy. A total of 227 patients were included in the study，and classified into two groups according to whether they started HCQ treatment during or six months prior to pregnancy，HCQ treatment group（n=108） and control group（n=119）. Results: Compared with the patients in the HCQ treatment group，we found that patients in the control group were more likely to have gestational hypertension（5.0% vs. 17.6%，P=0.003），preterm birth（19.3% vs. 25.0%，P=0.303），and low birth weight infant（20.0% vs. 45.0%，P<0.001）. Multivariate analysis showed that HCQ treatment was associated with an exceedingly lower risk of gestational hypertension（OR=0.31，95%CI=0.10-0.93，P=0.037），preterm birth（OR=0.28，95%CI=0.10-0.79，P=0.016） and low birth weight infant（OR=0.31，95%CI=0.13-0.72，P=0.006） after controlling for important confounding variables. Conclusion: Our study proved that HCQ treatment can significantly improve the pregnancy outcomes of patients with CTD，especially reduce the risk of gestational hypertension，preterm birth and low birth weight infant.