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Abstract：
OBJECTIVE: To investigate the fetal and maternal outcomes, risk factors of disease progression and adverse pregnancy outcomes (APOs) in patients with undifferentiated connective tissue disease (UCTD).
METHODS: This retrospective study described the outcomes of 106 pregnancies in patients with UCTD. The patients were divided into APOs group (n=53) and non-APOs group (n=53). The APOs were defined as miscarriage, premature birth, pre-eclampsia, premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), postpartum hemorrhage (PPH), and stillbirth, small for gestational age infant (SGA), low birth weight infant (LBW) and birth defects. The differences in clinical manifestations, laboratory data and pregnancy outcomes between the two groups were compared. Logistic regression analysis was performed to analyze the risk factors for APOs and the progression of UCTD to definitive CTD.
RESULTS: There were 99 (93.39%) live births, 4 (3.77%) stillbirths and 3 (2.83%) miscarriage, 20 (18.86%) preterm delivery, 6 (5.66%) SGA, 17 (16.03%) LBW, 11 (10.37%) pre-eclampsia, 7 (6.60%) cases IUGR, 19 (17.92%) cases PROM, 10 (9.43%) cases PPH. Compared with the patients without APOs, the patients with APOs had a higher positive rate of anti-SSA antibodies (73.58% vs. 54.71%, P=0.036), higher rate of leukopenia (15.09% vs. 3.77%, P=0.046), lower haemoglobin level [109.00 (99.50, 118.00) g/L vs. 124.00 (111.50, 132.00) g/L, P < 0.001].Multivariate Logistic regression analysis showed that leucopenia (OR=0.82, 95%CI: 0.688-0.994) was an independent risk factors for APOs in UCTD (P=0.042). Within a mean follow-up time of 5.00 (3.00, 7.00) years, the rate of disease progression to a definite CTD was 14.15%, including 8 (7.54%) Sjögren\'s syndrome, 4 (3.77%) systemic lupus erythematosus (SLE), 4 (3.77%) rheumatoid arthritis and 1 (0.94%) mixed connective tissue disease. Multivariate Cox proportional risk regression analysis showed that Raynaud phenomenon (HR=40.157, 95%CI: 3.172-508.326) was an independent risk factor for progression to SLE.
CONCLUSIONS: Leukopenia is an independent risk factor for the development of APOs in patients with UCTD. Raynaud\'s phenmon is a risk factor for the progression of SLE. Tight disease monitoring and regular follow-up are the key measures to prevent adverse pregnancy outcomes and predict disease progression in UCTD patients with pregnancy.
METHODS: This retrospective study described the outcomes of 106 pregnancies in patients with UCTD. The patients were divided into APOs group (n=53) and non-APOs group (n=53). The APOs were defined as miscarriage, premature birth, pre-eclampsia, premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), postpartum hemorrhage (PPH), and stillbirth, small for gestational age infant (SGA), low birth weight infant (LBW) and birth defects. The differences in clinical manifestations, laboratory data and pregnancy outcomes between the two groups were compared. Logistic regression analysis was performed to analyze the risk factors for APOs and the progression of UCTD to definitive CTD.
RESULTS: There were 99 (93.39%) live births, 4 (3.77%) stillbirths and 3 (2.83%) miscarriage, 20 (18.86%) preterm delivery, 6 (5.66%) SGA, 17 (16.03%) LBW, 11 (10.37%) pre-eclampsia, 7 (6.60%) cases IUGR, 19 (17.92%) cases PROM, 10 (9.43%) cases PPH. Compared with the patients without APOs, the patients with APOs had a higher positive rate of anti-SSA antibodies (73.58% vs. 54.71%, P=0.036), higher rate of leukopenia (15.09% vs. 3.77%, P=0.046), lower haemoglobin level [109.00 (99.50, 118.00) g/L vs. 124.00 (111.50, 132.00) g/L, P < 0.001].Multivariate Logistic regression analysis showed that leucopenia (OR=0.82, 95%CI: 0.688-0.994) was an independent risk factors for APOs in UCTD (P=0.042). Within a mean follow-up time of 5.00 (3.00, 7.00) years, the rate of disease progression to a definite CTD was 14.15%, including 8 (7.54%) Sjögren\'s syndrome, 4 (3.77%) systemic lupus erythematosus (SLE), 4 (3.77%) rheumatoid arthritis and 1 (0.94%) mixed connective tissue disease. Multivariate Cox proportional risk regression analysis showed that Raynaud phenomenon (HR=40.157, 95%CI: 3.172-508.326) was an independent risk factor for progression to SLE.
CONCLUSIONS: Leukopenia is an independent risk factor for the development of APOs in patients with UCTD. Raynaud\'s phenmon is a risk factor for the progression of SLE. Tight disease monitoring and regular follow-up are the key measures to prevent adverse pregnancy outcomes and predict disease progression in UCTD patients with pregnancy.
摘要：
目的：调查胎儿和产妇的结局，未分化结缔组织病（UCTD）患者疾病进展和不良妊娠结局（APO）的危险因素。
方法：这项回顾性研究描述了106例UCTD患者的妊娠结局。将患者分为APO组（n=53）和非APO组（n=53）。APO被定义为流产，早产,先兆子痫,胎膜早破（PROM），宫内生长受限（IUGR），产后出血（PPH），和死产，小于胎龄婴儿（SGA），低出生体重儿（LBW）和出生缺陷。临床表现的差异，比较两组的实验室数据和妊娠结局.采用Logistic回归分析APO的危险因素及UCTD进展为明确CTD。
结果：有99例（93.39%）活产，4例（3.77%）死胎和3例（2.83%）流产，20（18.86%）早产，6（5.66%）SGA，17（16.03%）LBW，11（10.37%）先兆子痫，7例（6.60%）IUGR，19例（17.92%）PROM，10例(9.43%)PPH。与没有APO的患者相比，APO患者抗SSA抗体阳性率较高(73.58%vs.54.71%,P=0.036),白细胞减少率高(15.09%vs.3.77%,P=0.046),较低的血红蛋白水平[109.00（99.50，118.00）g/L与124.00(111.50,132.00)g/L,P<0.001]。多因素Logistic回归分析显示,白细胞减少(OR=0.82,95CI:0.688~0.994)是UCTD患者APOs的独立危险因素(P=0.042)。在平均5.00(3.00,7.00)年的随访时间内，疾病进展到明确CTD的比率为14.15%，包括8例（7.54%）干燥综合征，4（3.77%）系统性红斑狼疮（SLE），4（3.77%）类风湿性关节炎和1（0.94%）混杂结缔组织病。多因素Cox比例风险回归分析显示，雷诺现象（HR=40.157，95CI：3.172～508.326）是SLE进展的独立危险因素。
结论：白细胞减少是UCTD患者发生APO的独立危险因素。雷诺现象是SLE进展的危险因素。严密的疾病监测和定期随访是预防UCTD患者妊娠不良妊娠结局和预测疾病进展的关键措施。
方法：这项回顾性研究描述了106例UCTD患者的妊娠结局。将患者分为APO组（n=53）和非APO组（n=53）。APO被定义为流产，早产,先兆子痫,胎膜早破（PROM），宫内生长受限（IUGR），产后出血（PPH），和死产，小于胎龄婴儿（SGA），低出生体重儿（LBW）和出生缺陷。临床表现的差异，比较两组的实验室数据和妊娠结局.采用Logistic回归分析APO的危险因素及UCTD进展为明确CTD。
结果：有99例（93.39%）活产，4例（3.77%）死胎和3例（2.83%）流产，20（18.86%）早产，6（5.66%）SGA，17（16.03%）LBW，11（10.37%）先兆子痫，7例（6.60%）IUGR，19例（17.92%）PROM，10例(9.43%)PPH。与没有APO的患者相比，APO患者抗SSA抗体阳性率较高(73.58%vs.54.71%,P=0.036),白细胞减少率高(15.09%vs.3.77%,P=0.046),较低的血红蛋白水平[109.00（99.50，118.00）g/L与124.00(111.50,132.00)g/L,P<0.001]。多因素Logistic回归分析显示,白细胞减少(OR=0.82,95CI:0.688~0.994)是UCTD患者APOs的独立危险因素(P=0.042)。在平均5.00(3.00,7.00)年的随访时间内，疾病进展到明确CTD的比率为14.15%，包括8例（7.54%）干燥综合征，4（3.77%）系统性红斑狼疮（SLE），4（3.77%）类风湿性关节炎和1（0.94%）混杂结缔组织病。多因素Cox比例风险回归分析显示，雷诺现象（HR=40.157，95CI：3.172～508.326）是SLE进展的独立危险因素。
结论：白细胞减少是UCTD患者发生APO的独立危险因素。雷诺现象是SLE进展的危险因素。严密的疾病监测和定期随访是预防UCTD患者妊娠不良妊娠结局和预测疾病进展的关键措施。
