Takayasu动脉炎妊娠期间临床管理的研究进展

doi:10.12114/j.issn.1007-9572.2022.0665

摘要/Abstract

摘要： Takayasu动脉炎是一种慢性肉芽肿性血管炎，主要累及主动脉及其主要分支，引起血管狭窄、闭塞和动脉瘤形成，对育龄期妇女有重要影响。大多数研究表明Takayasu动脉炎患者在妊娠期间病情较为稳定，但其仍有可能导致妊娠并发症，如妊娠期高血压、先兆子痫、早产及胎儿宫内生长受限等。为了降低Takayasu动脉炎对孕产妇和胎儿的不利影响，在妊娠期间控制疾病活动是非常有意义的。本文就Takayasu动脉炎对生殖系统的影响、与妊娠的相互作用以及对胎儿的影响进行详细阐述，同时对妊娠期及围生期的管理措施进行探讨，为今后Takayasu动脉炎妊娠期患者改善临床结局、提供多学科管理措施提供一定的参考。

关键词: Takayasu动脉炎, 妊娠并发症, 妊娠, 高血压, 妊娠性, 临床管理, 综述

Abstract:

Takayasu's arteritis (TA) is a chronic granulomatous vasculitis mainly affecting the aorta and its major branches, which can cause stenosis, occlusion and aneurysm formation, severely influencing the affected women of childbearing age. TA has been extensively studied to be stable during pregnancy, but it may lead to pregnancy complications such as gestational hypertension, pre-eclampsia, preterm delivery, and intrauterine growth restriction. To reduce the adverse effects of TA on the mother and fetus, it is essential to control the disease activity during pregnancy. This article details the effects of TA on the reproductive system, its interaction with pregnancy and effects on the fetus, discusses the management measures during pregnancy and the perinatal period in patients of childbearing age with TA, providing guidance for improving multidisciplinary management and clinical outcomes in these patients.

Key words: Takayasu arteritis, Pregnancy complications, Pregnancy, Hypertension, pregnancy-induced, Clinical governance, Review

刘颖宏,杨晓娟. Takayasu动脉炎妊娠期间临床管理的研究进展[J]. 中国全科医学, 2023, 26(35): 4483-4486. DOI: 10.12114/j.issn.1007-9572.2022.0665.
LIU Yinghong,YANG Xiaojuan. Recent Advances in Clinical Management of Takayasu's Arteritis in Pregnancy[J]. Chinese General Practice, 2023, 26(35): 4483-4486. DOI: 10.12114/j.issn.1007-9572.2022.0665.

参考文献 33

[1]	ESATOGLU S N，HATEMI G. Takayasu arteritis[J]. Curr Opin Rheumatol，2021，34（1）：18-24. DOI：10.1097/bor.0000000000000852.
[2]	GAO Q，WU Z Y，YU J G，et al. Single-cell RNA sequencing revealed CD14+ monocytes increased in patients with Takayasu's arteritis requiring surgical management[J]. Front Cell Dev Biol，2021，9：761300. DOI：10.3389/fcell.2021.761300.
[3]	COMARMOND C，SAADOUN D，NIZARD J，et al. Pregnancy issues in Takayasu arteritis[J]. Semin Arthritis Rheum，2020，50（5）：911-914. DOI：10.1016/j.semarthrit.2020.08.001.
[4]	BHARUTHRAM N，TIKLY M. Pregnancy and Takayasu arteritis: case-based review[J]. Rheumatol Int，2020，40（5）：799-809. DOI：10.1007/s00296-019-04499-y.
[5]	ABISROR N，MEKINIAN A，HACHULLA E，et al. Analysis of risk factors for complications and adverse obstetrical outcomes in women with Takayasu arteritis: a French retrospective study and literature review[J]. Clin Rheumatol，2020，39（9）：2707-2713. DOI：10.1007/s10067-020-05024-4.
[6]	KESER G，AKSU K，DIRESKENELI H. Takayasu arteritis: an update[J]. Turk J Med Sci，2018，48（4）：681-697. DOI：10.3906/sag-1804-136.
[7]	VANOLI M，DAINA E，SALVARANI C，et al. Takayasu's arteritis: a study of 104 Italian patients[J]. Arthritis Rheum，2005，53（9）：100-107. DOI：10.1002/art.20922.
[8]	DEROUX A，DUMESTRE-PERARD C，DUNAND-FAURE C，et al. Female infertility and serum auto-antibodies: a systematic review[J]. Clin Rev Allergy Immunol，2017，53（9）：78-86. DOI：10.1007/s12016-016-8586-z.
[9]	孙杰，曾鸿，王永清，等. 合并大动脉炎产妇行剖宫产术的围术期管理[J]. 北京大学学报（医学版），2016，48（4）：743-746. DOI：10.3969/j.issn.1671-167X.2016.04.035.
[10]	TANACAN A，UNAL C，YUCESOY H M，et al. Management and evaluation of pregnant women with Takayasu arteritis[J]. Arch Gynecol Obstet，2019，299（1）：79-88. DOI：10.1007/s00404-018-4927-x.
[11]	SILVA N L，WITHANA M，WEERATUNGA P，et al. Evolution into Takayasu arteritis in a patient presenting with acute pulmonary oedema due to severe aortic regurgitation: a case report[J]. BMC Rheumatol，2018，2：20. DOI：10.1186/s41927-018-0028-5.
[12]	GUDBRANDSSON B，WALLENIUS M，GAREN T，et al. Takayasu arteritis and pregnancy: a population-based study on outcomes and mother/child-related concerns[J]. Arthritis Care Res （Hoboken），2017，69（9）：1384-1390. DOI：10.1002/acr.23146.
[13]	GÖNENLI M G，KAYMAZ TAHRA S，KARA M，et al. Pregnancy in Takayasu's arteritis has a high risk of hypertension-related fetomaternal complications: a retrospective study of a Turkish cohort[J]. Int J Rheum Dis，2022，25（2）：140-146. DOI：10.1111/1756-185X.14247.
[14]	DAI Y Q，ZHONG Y，JIAN B H，et al. Bridging therapy for acute stroke as the initial manifestation of takayasu arteritis: a case report and review of literature[J]. Front Immunol，2021，12: 630619. DOI：10.3389/fimmu.2021.630619.
[15]	HE S P，LI Z，ZHANG G Z，et al. Pregnancy outcomes in Takayasu arteritis patients[J]. Semin Arthritis Rheum，2022，55: 152016. DOI：10.1016/j.semarthrit.2022.152016.
[16]	PADIYAR S，MANIKUPPAM P，KABEERDOSS J，et al. Update on pregnancy in Takayasu arteritis-A narrative review[J]. Int J Rheum Dis，2021，24（6）：758-765. DOI：10.1111/1756-185X.14109.
[17]	COMARMOND C，MIRAULT T，BIARD L，et al. Takayasu arteritis and pregnancy[J]. Arthritis Rheumatol，2015，67（12）：3262-3269. DOI：10.1002/art.39335.
[18]	GUPTA L，MISRA D P，AHMED S，et al. Poor obstetric outcomes in Indian women with Takayasu arteritis[J]. Adv Rheumatol，2020，60（1）：17. DOI：10.1186/s42358-020-0120-6.
[19]	DASARI P，GUMMADI H S. Pregnancy outcome in Takayasu arteritis[J]. BMJ Case Rep，2021，14（5）：e238014. DOI：10.1136/bcr-2020-238014.
[20]	高伟娜，刘冲，郭书忍，等. 妊娠合并大动脉炎对母儿结局的影响[J]. 中华妇产科杂志，2022，57（2）：91-100. DOI：10.3760/cma.j.cn112141-20210707-00364.
[21]	ROSS C，D'SOUZA R，PAGNOUX C. Pregnancy outcomes in systemic vasculitides[J]. Curr Rheumatol Rep，2020，22（10）：63. DOI：10.1007/s11926-020-00940-5.
[22]	DAVID L S，BECK M M，KUMAR M，et al. Obstetric and perinatal outcomes in pregnant women with Takayasu's arteritis: single centre experience over five years[J]. J Turk Ger Gynecol Assoc，2020，21（1）：15-23. DOI：10.4274/jtgga.galenos.2019.2019.0115.
[23]	FLINT J，PANCHAL S，HURRELL A，et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids[J]. Rheumatology（Oxford），2016，55（9）：1693-1697. DOI：10.1093/rheumatology/kev404.
[24]	SAMMARITANO L，RBERMAS B L，CHAKRAVARTY E E，et al. 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases[J]. Arthritis Rheumatol，2020，72（4）：529-556. DOI：10.1002/art.41191.
[25]	SINGHAL S，MEENA J，KUMAR S，et al. Maternal and perinatal outcomes of pregnancy in women with autoimmune disorder[J]. Cureus，2021，13（6）：e16024. DOI：10.7759/cureus.16024.
[26]	PYO J Y，SONG J J，PARK Y B，et al. Pregnancy morbidities in Korean patients with Takayasu arteritis: a monocentric pilot study[J]. Yonsei Med J，2020，61（11）：970-975. DOI：10.3349/ymj.2020.61.11.970.
[27]	李治琴，郑朝晖，庞琳烜，等. 大动脉炎妊娠风险研究分析[J]. 中华风湿病学杂志，2018，22（3）：186-190. DOI：10.3760/cma.j.issn.1007-7480.2018.03.009.
[28]	DALKILIC E，COSKUN B N，YAGIZ B，et al. A successful pregnancy in a patient with Takayasu's arteritis under tocilizumab treatment: a longitudinal case study[J]. Int J Rheum Dis，2019，22（10）：1941-1944. DOI：10.1111/1756-185X.13687.
[29]	ATA N，VARAN Ö，BABAOGLU H，et al. Certolizumab pegol treatment in three patients with takayasu arteritis[J]. Arch Rheumatol，2019，34（3）：357-362. DOI：10.5606/ArchRheumatol.2019.7177.
[30]	MISRA D P，RATHORE U，PATRO P，et al. Patient-reported outcome measures in Takayasu arteritis: a systematic review and meta-analysis[J]. Rheumatol Ther，2021，8（3）：1073-1093. DOI：10.1007/s40744-021-00355-3.
[31]	崔佳文，康心怡，单阎星，等. 妊娠合并大动脉炎一例[J]. 中华妇产科杂志，2020，55（8）：560-561. DOI：10.3760/cma.j.cn112141-20200430-00370.
[32]	SINGH S，GUPTA N，SREENIVASULU P，et al. Anesthetic management of Ehlers-Danlos syndrome patient with Takayasu arteritis for capsulorrhaphy of the temporomandibular joint[J]. J Anaesthesiol Clin Pharmacol，2021，37（1）：136-137. DOI：10.4103/joacp.JOACP_301_19.
[33]	KASSA M W，BENTI T M，BEDADA A G. Successful spinal anaesthesia for caesarean section in an African patient with Takayasu's arteritis[J]. Pan Afr Med J，2018，30：281. DOI：10.11604/pamj.2018.30.281.16182.