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DOI: 10.23648/UMBJ.2018.29.11354

УДК 618.2:616-097:618.3-06

БЕРЕМЕННОСТЬ И СИСТЕМНАЯ КРАСНАЯ ВОЛЧАНКА

Р.Н. Степанова

ФГБОУ ВО «Орловский государственный университет им. И.С. Тургенева», г. Орел, Россия

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Системная красная волчанка (СКВ) – аутоиммунное заболевание, поражающее многие органы и системы человека. При СКВ образуется большое количество антител к антигенам собственных клеток, вследствие чего развивается иммунокомплексный воспалительный процесс, поражающий сердце, кожу, почки, легкие, суставы, нервную систему. При СКВ утрачивается фундаментальное свойство иммунной системы – толерантность к аутоантигенам, в результате продуцируются антитела, атакующие нормальные ткани собственного организма, что сопровождается развитием аутоиммунных заболеваний. У больных СКВ появляются такие клинические манифестации, как множественный тромбоз, в т.ч. ТЭЛА, заболевания ЦНС, livedo reticularis, лабильная гипертензия, привычный выкидыш. СКВ поражает людей всех рас, мужчин и женщин, однако у последних она доминирует и особенно часто развивается у женщин репродуктивного возраста. Распространенность СКВ среди женщин репродуктивного возраста – 1:500. Почти 90 % больных волчанкой – женщины. Причины развития СКВ неизвестны. В настоящее время общепризнано, что такие осложнения гестации, как привычный аборт, преэклампсия и эклампсия, преждевременная отслойка плаценты, ДВС- и HELLP-синдромы, тромбозы, задержка внутриутробного роста плода, мертворождаемость, ассоциируются с аутоиммунными заболеваниями у матери. Механизм, которым СКВ отягощает течение беременности и ухудшает ее исходы для матери, плода, новорожденного, остается нерасшифрованным. Возможно, к этому причастны сосудистые поражения плаценты, имеющие природу, сходную с волчаночными поражениями сосудов при СКВ. Репродуктивные потери у пораженных СКВ матерей, особенно при клинически активной волчанке, могут достигать 45 %. В статье анализируется литература, касающаяся проблем взаимовлияния СКВ и беременности, клинического течения волчанки у беременной женщины, материнского и перинатального исхода гестации, частоты развития неонатального люпуса.

Ключевые слова: системная красная волчанка, осложнения беременности, исходы беременности, неонатальный люпус.

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DOI: 10.23648/UMBJ.2018.29.11354

PREGNANCY AND SYSTEMIC LUPUS ERYTHEMATOSUS

R.N. Stepanova

Orel State University named after I.S. Turgenev, Orel, Russia

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Systemic lupus erythematosus (SLE) is an autoimmune disease that affects many human organs and systems. In patients with SLE a large number of antibodies to the antigens of their own cells is formed. It leads to an immunocomplex inflammatory process, which affects heart, skin, kidneys, lungs, joints, and the nervous system. SLE contributes to the failure of a fundamental characteristic of the immune system, namely tolerance to autoantigens. As a result, antibodies that attack normal tissues in many parts of the body are produced. This process is accompanied by autoimmune disease development. Patients with
SLE demonstrate such clinical manifestations as multiple thrombosis, including pulmonary embolism (PE), CNS diseases, livedo reticularis, labile hypertension, habitual miscarriage. SLE affects people of all races, men and women, but it dominates in women and often develops in females of reproductive age.
SLE prevalence among women of reproductive age is 1:500. Nearly 90 % of patients diagnosed with lupus are women. The reasons for SLE development are unknown. Now it is generally accepted, that gestational complications such as habitual abortion, preeclampsia and eclampsia, premature placental abruption, disseminated intravascular coagulation (DIC) and HELLP syndromes, thromboses, intrauterine growth retardation, and stillbirth are associated with maternal autoimmune diseases. However, the mechanism how SLE interferes with pregnancy and worsens its outcomes for the mother, fetus, and newborn remains unidentified. Probably, vascular lesions of the placenta contribute to the process, as their nature is similar to the lupus vascular disease in patients with SLE. Reproductive loss in SLE mothers, especially in clinically active lupus, can reach 45 %. The article analyzes the literature on the problems of interaction between SLE and pregnancy, the lupus clinical course in pregnant women, the maternal and perinatal gestational outcome, and neonatal lupus frequency.

Keywords: systemic lupus erythematosus, pregnancy complications, pregnancy outcomes, neonatal lupus.

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