风湿

孕期服用抗疟药可降低心脏新生儿狼疮发生风险?

作者:Barsalou J, et al. 北医三院李常虹 来源:医学界风湿免疫频道 日期:2017-11-09
导读

         本大型单中心队列研究提示,孕期服用抗疟药与心脏的新生儿狼疮发生风险下降相关,而与非心脏的新生儿狼疮发生风险下降无关。

关键字:  孕期 | 抗疟药 |  

        摘要:

        目的:近期的研究提示孕期服用羟氯喹可降低心脏新生儿狼疮的发生风险。本研究旨在探讨整个孕期母体均服用抗疟药是否能够降低心脏和非心脏新生儿狼疮的发生风险。

        方法:本单中心回顾性队列研究计划纳入了自1984年1月1日至2013年10月1日期间有结缔组织病且抗Ro和/或抗La抗体阳性女性生育的所有儿童。但经过筛选315例中有268例被纳入了本项研究。

        抗疟药的暴露情况定义为整个孕期均服用羟氯喹或氯喹。研究结果既观察心脏和非心脏新生儿狼疮的发生情况。我们的研究假设是孕期服用抗疟药可降低心脏而不是非心脏新生儿狼疮的发生风险。

        结果:总共268例孕妇被纳入本项研究,其中73例整个孕期均服用了抗疟药。99例儿童出现了新生儿狼疮,117例儿童未受任何影响,52例儿童虽没有出现心脏的新生儿狼疮,但因缺乏全面的非心脏的新生儿狼疮的相关资料,所以这部分儿童也不能被视为完全不受影响。

        逻辑回归分析提示抗疟药的使用对于心脏的新生儿狼疮具有保护作用,但没有统计学显著差异。后续的贝叶斯分析提示服用抗疟药获得保护性作用的可能性还是非常显著的(98.7%)。但抗疟药的使用对于非心脏的新生儿狼疮的保护作用却不显著。

        结论:本大型单中心队列研究提示,孕期服用抗疟药与心脏的新生儿狼疮发生风险下降相关,而与非心脏的新生儿狼疮发生风险下降无关。

        附原文:

        AbstractObjective:Recent studies have suggested that prenatal exposure to HCQ reduces the risk of cardiac neonatal lupus. The aim of this study is to assess if maternal intake of antimalarials (AMs) throughout pregnancy lowered the risk of cardiac and non-cardiac neonatal lupus.

        Methods:Consecutive children seen between 1 January 1984 to 1 October 2013 born to women with a CTD and positive anti-Ro and/or anti-La antibodies were eligible for this single-centre retrospective cohort study.

        A total of 315 individuals were screened and 268 participants were included. Exposure to AMs was defined as HCQ or chloroquine throughout pregnancy. Outcomes were cardiac and non-cardiac neonatal lupus. Frequentist and Bayesian analyses were performed. We hypothesized that prenatal AM exposure would decrease the risk of cardiac but not non-cardiac neonatal lupus.

        Results:A total of 268 pregnancies were included; 73 were exposed to AMs throughout pregnancy. Ninety-nine children developed neonatal lupus, 117 remained unaffected and 52 children did not develop cardiac neonatal lupus but could not be categorized as unaffected since their full non-cardiac neonatal lupus status was unknown.

        Logistic regression suggested a protective effect of AM on cardiac neonatal lupus, but results were not statistically significant [odds ratio (OR) 0.21; P = 0.07]. Bayesian analysis showed that the probability of obtaining a protective effect (OR < 1.0) for cardiac neonatal lupus was significant (98.7%). The effect of AMs on non-cardiac neonatal lupus was not significant (OR 0.78; P = 0.21).

        Conclusion:In this large single-centre cohort study, exposure to AMs throughout pregnancy was associated with a decreased probability of developing cardiac but not non-cardiac neonatal lupus.

        引自:Barsalou J, Jaeggi E, Laskin CA, Brown P, Tian SY, Hamilton RM, Silverman ED.Prenatal exposure to antimalarials decreases the risk of cardiac but not non-cardiac neonatal lupus: a single-centre cohort study. Rheumatology (Oxford).2017 Sep 1;56(9):1552-1559. doi: 10.1093/rheumatology/kex191.

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