Analysis Of Pregnancy Outcomes In Patients With SLE And Th1/Th2 Associated Transcription Factor In SLE Pregnancy

Part 1.Clinical Research.Analysis of pregnancy outcomes in patients with systemic lupus erythematosus ObjectiveThis study analyzed the clinical characteristics and pregnancy outcomes of patients with systemic lupus erythematosus(SLE)to explore the related risk factors of adverse pregnancy outcomes(APO).MethodWe retrospectively analyzed the clinical data of 144 cases of pregnancies with SLE who were hospitalized in the Affiliated Hospital of Qingdao University from January 2005 to March 2019.We analyzed the general information,history,clinical manifestations,laboratory examination,pregnancy outcomes and neonatal prognosis.The relevant conclusions are drawn by using the method of statistical analysis.Result1.A total of 144 SLE pregnancies were included in this study.Of the 80 multiparas,25 cases(17.4%)had an adverse pregnancy history,including 6 cases(4.2%)of spontaneous abortion and 16 cases(11.1%)of embryo abortion.There were 34 cases(23.6%)of disease activity during pregnancy and 31 cases(21.5%)of hypertensive disorders of pregnancy(HDPs),including 11 cases with hypertension during pregnancy,16 cases(11.1%)with preeclampsia,4 cases(2.8%)with chronic hypertension during pregnancy and 1 case(0.7%)with maternal death.There were 66 cases(45.8%)with adverse pregnancy outcome,including 44 cases(30.5%)of premature delivery,13 cases(9.0%)of pregnancy loss,8 cases(5.6%)of fetal distress and 36 cases(25%)of SGA.During pregnancy,22 cases(15.3%)were treated with prednisone>15mg/day,103 cases(71.5%)were treated with HCQ,9 cases(6.3%)with cyclosporine,28 cases(19.4%)with tacrolimus,32 cases(22.2%)with aspirin and 39 cases(27.1%)with Low molecular weight heparin.2.The incidences of premature delivery,preeclampsia,pregnancy loss and SGA in the active SLE group were significantly higher than those in the stable group,and the differences were statistically significant(P<0.05).Neonatal weights in the active SLE group were also lower than those in the stable group(P<0.05).3.The percentages of patients with lupus nephritis,HDPs,preeclampsia,thrombocytopenia,anemia,hypoproteinemia,complement reduction,urine protein>0.5g/24 h,high-dose hormone and tacrolimus used in the APO group were higher than those in the non-APO group.In addition,the SLEDAI score during pregnancy in the APO group was higher,and the differences were statistically significant(P<0.05).Pregnancy complicated with HDPs(OR 6.91,95%CI 2.15-22.20,P=0.001),urinary protein>0.5g/24 h(OR 4.48,95%CI 1.40-14.32,P=0.011),and decreased complement(OR 3.27,95%CI 1.38-7.75,P=0.007)were the independent risk factors for APO.The area under the curve of APO risk factors combined with ROC was larger than that of single factor.Conclusion1.Prematurity,preeclampsia,pregnancy loss and SGA are closely related to the activity of SLE during pregnancy.2.SLE pregnancies complicated with hypertension,urine protein>0.5g/24h,and the decrease of complement were the independent risk factors for APO.3.Pregnancy complicated with lupus nephritis,thrombocytopenia,anemia,hypoproteinemia,high-dose hormone used during pregnancy were associated with adverse pregnancy outcomes.Part 2.Experimental Research.Th1/Th2 associated transcription factor in pregnancy with systemic lupus erythematosusObjectiveTo investigate the changes of Th1/Th2 associated transcription factors and cytokines and its clinical relevance in patients with SLE during pregnancy.MethodTwenty-five SLE pregnancies from September 2021 to March 2022 were enrolled in the study.Twenty-two age,gestational age-matched normal pregnancies were recruited as control group.Peripheral blood mononuclear cells(PBMC)were isolated from the peripheral blood by density gradient centrifugation.Real-time quantitative reverse transcription polymerase chain reaction(qPCR)was used for T-bet,GATA3,IFN-y and IL-4 mRNA quantifications.Main statistical analysis methods were t test,Mann-Whitney U-test analysis.Result1.The mRNA levels of IFN-γ and the relative expression levels of T-bet/GATA3 and IFN-γ/IL-4 were significantly higher,in contrast to the lower expressions of GATA3,in SLE pregnancies than controls and the difference were statistically significant(P<0.001,P<0.05,P<0.05 and P<0.01,respectively).2.In the third trimester,the expression level of GATA3 in SLE patients during late pregnancy was significantly lower than that in controls(P<0.05).While the mRNA levels of IFN-y and the relative expressions of T-bet/GATA3 and IFN-γ/IL-4 were higher in SLE than that in controls(P<0.05,P<0.01 and P<0.05,respectively).Conclusion1.The Th1 cytokine function represented by IFN-y may be up-regulated during pregnancy in SLE patients.2.The Th2 polarization in peripheral blood of pregnant patients with SLE was significantly lower than that of healthy pregnancy controls.3.The degree of Th2 polarization in the third trimester of pregnancy in SLE patients did not reach the expected level.