母亲用羟氯喹可降低抗SSA抗体相关新生儿狼疮心脏受累风险

艾伯维风湿免疫组医学事务专员 金晶

摘要 ：背景：一项最近的病例对照研究表明，HCQ有助于降低抗SSA/Ro阳性的SLE孕产妇患者中新生儿狼疮的心脏表现(NL心脏病)的风险。本研究基于3个国际数据库构建了一个历史群体，用于评估是否不管孕产妇健康状况如何，HCQ可独立降低NL心脏病近增高十倍的再发风险。

方法和结果：从3个数据库(分别来自美国、英国和法国)中选取之前生育过NL心脏病新生儿的257名抗SSA/Ro阳性孕产妇患者(40例暴露于HCQ，217例未暴露于HCQ)。暴露的定义为妊娠前10周开始并于整个怀孕期间持续使用HCQ。HCQ暴露组与未暴露组的胎儿中，NL心脏病的再发率分别为7.5% (3/40)和21.2% (46/217)，二者存在显著差异(P = 0.050)。未暴露组中NL心脏病的新生儿总死亡率为21.7％，然而HCQ暴露组未出现死亡病例。对数据库资源、母亲的种族/民族和抗SSB/La状态进行标化的多变量分析表明，HCQ的使用与NL心脏病风险降低显著相关(OR: 0.23; 95% CI, 0.06-0.92; P = 0.037)；对可能产生混杂的表征采取倾向性评分分析亦获得类似的结果。

结论：汇总多国的数据表明，NL心脏病高风险女性使用HCQ可能预防后继怀孕中该疾病的发生。

附原文： Abstract BACKGROUND: A recent case-control study suggested a benefit of hydroxychloroquine (HCQ) in lowering the risk of cardiac manifestations of neonatal lupus (cardiac-NL) in pregnancies of anti-SSA/Ro-positive patients with systemic lupus erythematosus. A historical cohort assembled from 3 international databases was used to evaluate whether HCQ reduces the nearly 10-fold increase in risk of recurrence of cardiac-NL independently of maternal health status.METHODS AND RESULTS: Two hundred fifty-seven pregnancies of anti-SSA/Ro-positive mothers (40 exposed and 217 unexposed to HCQ) subsequent to the birth of a child with cardiac-NL were identified from 3 databases (United States, England, and France). Exposure was defined as the sustained use of HCQ throughout pregnancy with initiation before 10 weeks of gestation. The recurrence rate of cardiac-NL in fetuses exposed to HCQ was 7.5% (3 of 40) compared with 21.2% (46 of 217) in the unexposed group (P=0.050). Although there were no deaths in the exposed group, the overall case fatality rate of the cardiac-NL fetuses in the unexposed group was 21.7%. In a multivariable analysis that adjusted for database source, maternal race/ethnicity, and anti-SSB/La status, HCQ use remained significantly associated with a decreased risk of cardiac-NL (odds ratio, 0.23; 95% confidence interval, 0.06-0.92; P=0.037). Similar results were obtained with propensity score analysis, an alternative approach to adjust for possible confounding by indication.CONCLUSION: Aggregate data from a multinational effort show that in mothers at high risk of having a child with cardiac-NL, the use of HCQ may protect against recurrence of disease in a subsequent pregnancy.

引自： Izmirly PM, Costedoat-Chalumeau N, Pisoni CN, et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation. 2012 Jul 3;126(1):76-82