Retrospective analysis of the effect of plasmapheresis in pregnant patients with systemic lupus erythematosus / 中华风湿病学杂志

ABSTRACT

Objective:To analyze the clinical efficacy of prednisone, hydroxychloroquine (HCQ) combined with plasmapheresis (PE) or not for the treatment of systemic lupus erythematosus (SLE) during pregnancy.Methods:Fourteen patients with SLE during pregnancy were analyzed. Totally 7 patients in the non-PE group were given prednisone and HCQ only while 7 patients in PE group were given prednisone and HCQ combined with PE. The fetus outcomes and clinical data, such as erythrocyte sedimentation tate (ESR), urine protein level, blood cell count and systemic lupus erythematosus disease activity index (SLEDAI) score before and after treatment at 3, 6, 12 months were used to evaluate the efficacy between the two groups. The comparison between groups was performed by repeated measures analysis of varianc (ANOVA).Results:Totally 11 patients delivered successfully in both groups while three of the 7 patients in the non-PE group had stillbirth. The 11 fetuses developed well and were born with an Apgar score of 8 or more at birth in both groups. There was a significant difference in ESR and platelet counts between the two groups ( F=7.838, P<0.05 ; F=32.269 , P<0.05). The ESR of the PE group was lower than that in the non-PE group at 3, 6 and 12 months after delivery, while the platelet count was higher than that in the non-PE group. Although there was no significant difference in the SLEDAI scores between the two groups ( F=2.816, P=0.119), the average of SLEDAI scores in the PE group was lower than that in the non-PE group at 3, 6 and 12 months after delivery. In addition, the urine protein of 7 patients in the PE group turned negative at 6, 12 months after delivery. In the non-PE group, urinary protein-positive patients were present in 3, 6, 12 months after delivery. Conclusion:PE in combination with oral prednisone and HCQ is a more effective than oral prednisone and HCQ alone for patients with active SLE during pregnancy, which reduces pregnancy loss and promote the patient's outcome.