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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (6): 1074-1080. doi: 10.19723/j.issn.1671-167X.2025.06.009

• 论著 • 上一篇    下一篇

阿司匹林对系统性红斑狼疮妊娠者结局的影响

李欣艺, 赵金霞, 穆荣*()   

  1. 北京大学第三医院风湿免疫科，北京 100191
  • 收稿日期:2025-08-18 出版日期:2025-12-18 发布日期:2025-10-24
  • 通讯作者: 穆荣

Impact of aspirin use on pregnancy outcomes in patients with systemic lupus erythematosus

Xinyi LI, Jinxia ZHAO, Rong MU*()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2025-08-18 Online:2025-12-18 Published:2025-10-24
  • Contact: Rong MU

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摘要：

目的: 评估系统性红斑狼疮(systemic lupus erythematosus，SLE)妊娠者使用阿司匹林的情况，以及其对妊娠结局的影响。方法: 连续纳入2010—2024年于北京大学第三医院产科出院的SLE患者，记录患者的一般情况(年龄，不良妊娠史，血栓、高血压、肾脏病病史)、受累脏器、抗磷脂抗体、妊娠期SLE疾病活动度评分(systemic lupus erythematosus disease activity index，SLEDAI)、妊娠期SLE用药方案以及妊娠结局。比较阿司匹林用药组和未用组之间临床特点的差异，Logistic回归分析评估阿司匹林对妊娠结局的影响。结果: 共纳入171例SLE患者，平均年龄为(31±4)岁，46例患者合并不良妊娠史。受累脏器以皮肤、关节最为常见，分别为68.4%和45.6%，肾脏受累52例，占30.4%。87.1%的患者妊娠期SLEDAI评分≤4分。阿司匹林使用比例占48.5%(83/171)，其中在2010—2017年使用比例为43.2%，2017年以后为50.4%，呈增长趋势。171例SLE患者妊娠后出现胎儿丢失、早产、子痫前期/子痫、早发子痫的比例分别为14.0%、23.4%、22.8%、10.5%。调整年龄、不良妊娠史、SLEDAI评分、抗磷脂抗体等协变量后，阿司匹林使用是活产的保护因素(OR＝2.34，95%CI：1.18~4.65，P＝0.015)，可以降低子痫前期/子痫、早发子痫的发生比例(分别为OR＝0.42，95%CI：0.19~0.91，P＝0.028；OR＝0.31，95%CI：0.11~0.89，P＝0.029)。在无子痫前期/子痫高危因素的SLE妊娠者中，阿司匹林使用是活产的保护因素(OR＝8.22, 95%CI：1.61~42.16，P＝0.012)，可能有助于降低早发子痫前期/子痫发生比例(OR＝0.26，95%CI：0.06~1.10，P＝0.067)。结论: 阿司匹林可降低SLE妊娠者子痫前期/子痫、早发子痫、胎儿丢失的比例，对于无子痫前期/子痫高危因素的SLE妊娠者也需在医生的评估和建议下使用阿司匹林。SLE患者妊娠期管理在临床实践中与指南建议尚存在差距，需要进一步规范管理。

关键词: 系统性红斑狼疮, 妊娠, 阿司匹林, 妊娠结局

Abstract:

Objective: To evaluate the use of aspirin during pregnancy in patients with systemic lupus erythematosus (SLE) and to assess its effects on pregnancy outcomes. Methods: We consecutively enrolled SLE patients discharged from the Department of Obstetrics at Peking University Third Hospital between 2010 and 2024. Collected data included general patient characteristics, such as age, histories of adverse pregnancy, thrombosis, hypertension and renal disease. SLE related organ involvement, antiphospholipid antibodies (aPLs), SLE disease activity index (SLEDAI) score, medication regimens during pregnancy, and pregnancy outcomes were all documented. Differences in clinical characteristics between the aspirin user group and the non-user group were compared. Logistic regression analysis was used to assess the impact of aspirin on pregnancy outcomes. Results: A total of 171 SLE patients were included in this study. The mean age was (31±4) years, and 46 patients had a history of adverse pregnancy. The most commonly involved organs were skin and joints, accounting for 68.4% and 45.6% respectively. In the study, 52 cases had renal involvement, accounting for 30.4%. SLEDAI scores during pregnancy of the 87.1% patients were less than 4 scores. Aspirin use during pregnancy accounted for 48.5%. Among them, 19 patients (11.1%) used between 2010 and 2017, while 64 patients (37.4%) used after 2017, demonstrating an increasing trend. Regarding pregnancy outcomes, the rates of fetal loss, preterm birth, preeclampsia/eclampsia, and early-onset preeclampsia were 14.0%, 23.4%, 22.8%, and 10.5%, respectively. After adjusting for covariates such as age, adverse pregnancy history, SLEDAI score, and aPLs, aspirin use was a protective factor for live birth (OR=2.34, 95%CI: 1.18－4.65, P=0.015) and reduced the incidence of preeclampsia/eclampsia and early-onset preeclampsia (OR=0.42, 95%CI: 0.19－0.91, P=0.028; OR=0.31, 95%CI: 0.11－0.89, P=0.029, respectively) for the total 171 SLE patients. Among the SLE pregnant patients without high-risk factors for preeclampsia/eclampsia, aspirin use was a protective factor for live birth (OR=8.22, 95%CI: 1.61－42.16, P=0.012) and might help reduce the incidence of early-onset preeclampsia/eclampsia (OR=0.26, 95%CI: 0.06－1.10, P=0.067). Conclusion: Aspirin can reduce the incidence of preeclampsia/eclampsia, early-onset preeclampsia, and stillbirth in pregnant SLE patients. Even for those without high-risk factors for preeclampsia/eclampsia, aspirin should be taken under physician evaluation and recommendation. Current clinical practice in managing SLE during pregnancy deviates from guideline recommendations, underscoring the need for greater standardization.

Key words: Systemic lupus erythematosus, Pregnancy, Aspirin, Pregnancy outcome

中图分类号: 

  • R714.25

表1

171例SLE患者一般情况"

Characteristic Data
Age/years 31.0±3.9
Adverse pregnancy history 46 (26.9)
Gestational SLEDAI score
    Inactive 149 (87.1)
    Active 22 (12.9)
Organ involvement
    Skin 117 (68.4)
    Joints 78 (45.6)
    Hematological 42 (24.6)
    Renal 52 (30.4)
    Neurological 9 (5.3)
    Muscular 3 (1.7)
    Fever 41 (24.0)
    Thrombosis history 7 (4.1)
    aPLs positive 33 (19.3)
Medications during pregnancy
    Glucocorticoids 143 (83.6)
    Hydroxychloroquine 157 (91.8)
    Aspirin 83 (48.5)
    LMWH 52 (30.4)
    Immunosuppressants 50 (29.2)

表2

171例SLE妊娠患者阿司匹林用药组和未用组临床特点比较"

Characteristic Aspirin user (n=83) Non-user (n=88) P
Age/years 31.9±3.4 30.2±4.2 0.003
Adverse pregnancy history 28 (33.7) 18 (20.5) 0.052
Gestational SLEDAI Score
    Inactive 78 (94.0) 71 (80.7) 0.009
    Active 5 (6.0) 17 (19.3)
Clinical manifestations
    Skin 57 (68.7) 60 (68.2) 0.949
    Joints 35 (42.2) 43 (48.9) 0.382
    Hematological 21 (25.3) 21 (23.9) 0.826
    Renal 29 (34.9) 23 (26.1) 0.211
    Neurological 5 (6.0) 4 (4.6) 0.741
    Muscular 1 (1.2) 2 (2.3) >0.999
    Fever 22 (26.5) 19 (21.6) 0.456
Thrombosis history 3 (3.6) 4 (4.5) >0.999
aPLs positive 25 (30.1) 11 (12.5) 0.004
Medications during pregnancy
    Glucocorticoids 72 (86.7) 71 (80.7) 0.293
    Hydroxychloroquine 81 (97.6) 77 (87.5) 0.013
    LMWH 37 (44.6) 14 (15.9) < 0.001
    Immunosuppressants 30 (36.1) 20 (22.7) 0.049
Pregnancy outcomes
    Live birth 75 (90.4) 72 (81.8) 0.108
    Preeclampsia/eclampsia 19 (22.9) 20 (22.7) 0.979
    Early-onset preeclampsia/eclampsia 7 (8.4) 11 (12.5) 0.387
    Adverse pregnancy outcomes 40 (48.2) 52 (59.1) 0.151

表3

SLE妊娠患者阿司匹林用药对妊娠结局影响的Logistic回归分析"

Variable OR 95%CI P
Pregnancy outcome 1: Live birth
    Aspirin use 2.34 1.18-4.65 0.015
    Age 0.97 0.90-1.04 0.376
    Adverse pregnancy history 0.52 0.27-1.00 0.050
    Gestational SLEDAI score 0.30 0.12-0.72 0.007
    aPLs positive 0.35 0.16-0.76 0.008
    Hydroxychloroquine use 2.46 0.84-7.21 0.102
    LMWH use 1.35 0.64-2.84 0.431
    Immunosuppressants use 0.78 0.40-1.52 0.463
Pregnancy outcome 2: Preeclampsia/eclampsia
    Aspirin use 0.42 0.19-0.91 0.028
    Age 1.02 0.93-1.11 0.718
    Adverse pregnancy history 1.25 0.63-2.48 0.525
    Gestational SLEDAI score 2.68 1.18-6.09 0.019
    aPLs positive 1.56 0.75-3.25 0.234
    Hydroxychloroquine use 0.65 0.25-1.70 0.381
    LMWH use 1.18 0.58-2.41 0.649
    Immunosuppressants use 1.42 0.73-2.76 0.302
Pregnancy outcome 3: Early-onset preeclampsia/eclampsia
    Aspirin use 0.31 0.11-0.89 0.029
    Age 0.96 0.85-1.08 0.487
    Adverse pregnancy history 1.42 0.56-3.61 0.456
    Gestational SLEDAI score 3.82 1.45-10.08 0.007
    aPLs positive 2.45 1.02-5.89 0.045
    Hydroxychloroquine use 0.42 0.11-1.62 0.208
    LMWH use 1.85 0.75-4.56 0.182
    Immunosuppressants use 1.68 0.68-4.16 0.261
Pregnancy outcome 4: Adverse pregnancy outcomes
    Aspirin use 0.58 0.32-1.05 0.071
    Age 1.04 0.97-1.12 0.312
    Adverse pregnancy history 1.48 0.83-2.64 0.186
    Gestational SLEDAI score 2.25 1.05-4.82 0.037
    aPLs positive 1.92 1.02-3.62 0.044
    Hydroxychloroquine use 0.78 0.35-1.74 0.542
    LMWH use 1.34 0.74-2.43 0.337
    Immunosuppressants use 1.28 0.73-2.25 0.386

表4

无子痫高危因素SLE妊娠患者阿司匹林用药组和未用组临床特点比较"

Characteristic Aspirin user (n=30) Non-user (n=54) P
Age/years 31.6±4.1 30.4±4.6 0.223
Adverse pregnancy history 9 (30.0) 18 (33.3) 0.755
Gestational SLEDAI score
    Inactive 29 (96.7) 50 (92.6) 0.650
    Active 1 (3.3) 4 (7.4)
Clinical manifestations
    Skin 20 (66.7) 36 (66.7) 0.540
    Joints 13 (43.3) 29 (53.7) 0.362
    Hematological 6 (20.0) 9 (16.7) 0.700
    Neurological 0 (0) 2 (3.7) 0.535
    Muscular 1 (3.3) 1 (1.9) 1.000
    Fever 10 (33.3) 12 (22.2) 0.267
Medications during pregnancy
    Glucocorticoids 26 (86.7) 45 (83.3) 0.692
    Hydroxychloroquine 30 (100) 50 (92.6) 0.292
    LMWH 8 (26.7) 3 (5.6) 0.012
    Immunosuppressants 10 (33.3) 11 (20.4) 0.189
Pregnancy outcomes
    Live birth 30 (100.0) 48 (88.9) < 0.001
    Preeclampsia/eclampsia 4 (13.3) 6 (11.1) 0.763
    Early-onset preeclampsia/eclampsia 1 (3.3) 1 (1.9) 0.669
    Adverse pregnancy outcomes 11 (36.7) 26 (48.1) 0.310

表5

无子痫高危因素SLE妊娠患者阿司匹林用药对妊娠结局影响的Logistic回归分析"

Variable OR 95%CI P
Pregnancy outcome 1: Live birth
    Aspirin use 8.22 1.61-42.16 0.012
    Age 0.96 0.87-1.07 0.465
    Gestational SLEDAI score 1.24 0.80-1.91 0.330
    Hydroxychloroquine use 6.31 1.10-36.26 0.039
    LMWH use 0.59 0.13-2.74 0.503
Pregnancy outcome 2: Preeclampsia/eclampsia
    Aspirin use 0.44 0.13-1.50 0.191
    Age 1.05 0.96-1.15 0.256
    Gestational SLEDAI score 1.31 0.89-1.91 0.168
    Hydroxychloroquine use 0.48 0.14-1.70 0.255
    LMWH use 0.65 0.17-2.51 0.534
Pregnancy outcome 3: Early-onset preeclampsia/eclampsia
    Aspirin use 0.26 0.06-1.10 0.067
    Age 1.07 0.96-1.18 0.216
    Gestational SLEDAI score 1.46 0.96-2.22 0.077
    Hydroxychloroquine use 0.38 0.09-1.68 0.205
    LMWH use 0.41 0.08-2.02 0.272
Pregnancy outcome 4: Adverse pregnancy outcomes
    Aspirin use 0.68 0.24-1.93 0.466
    Age 1.03 0.95-1.12 0.514
    Gestational SLEDAI score 1.21 0.84-1.74 0.307
    Hydroxychloroquine use 0.66 0.22-2.01 0.465
    LMWH use 1.37 0.24-1.93 0.466
1
Singh M , Wambua S , Lee SI , et al. Autoimmune diseases and adverse pregnancy outcomes: An umbrella review[J]. Lancet, 2023, 402 (Suppl 1): S84.
2
Clowse MEB , Jamison M , Myers E , et al. A national study of the complications of lupus in pregnancy[J]. Am J Obstet Gynecol, 2008, 199 (2): 127.e1- 127.e6.

doi: 10.1016/j.ajog.2008.03.012
3
Buyon JP , Kim MY , Guerra MM , et al. Predictors of pregnancy outcomes in patients with lupus[J]. Ann Intern Med, 2015, 163 (3): 153- 163.

doi: 10.7326/M14-2235
4
Sangah AB , Jabeen S , Hunde MZ , et al. Maternal and fetal outcomes of SLE in pregnancy: A literature review[J]. J Obstet Gynaecol, 2023, 43 (1): 2205513.

doi: 10.1080/01443615.2023.2205513
5
Schramm AM , Clowse MEB . Aspirin for prevention of preeclampsia in lupus pregnancy[J]. Autoimmune Dis, 2014, 2014, 920467.
6
Roberge S , Villa P , Nicolaides K , et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: A systematic review and meta-analysis[J]. Fetal Diagn Ther, 2012, 31 (3): 141- 146.

doi: 10.1159/000336662
7
Duley L , Henderson-Smart DJ , Meher S , et al. Antiplatelet agents for preventing pre-eclampsia and its complications[J]. Cochrane Database Syst Rev, 2007, 18 (2): CD004659.
8
Hoffman MK , Goudar SS , Kodkany BS , et al. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): A randomised, double-blind, placebo-controlled trial[J]. Lancet, 2020, 395 (10220): 285- 293.

doi: 10.1016/S0140-6736(19)32973-3
9
Fanouriakis A , Kostopoulou M , Andersen J , et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update[J]. Ann Rheum Dis, 2024, 83 (1): 15- 29.

doi: 10.1136/ard-2023-224762
10
Andreoli L , Bertsias GK , Agmon-Levin N , et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome[J]. Ann Rheum Dis, 2017, 76 (3): 476- 485.

doi: 10.1136/annrheumdis-2016-209770
11
Sammaritano LR , Bermas BL , Chakravarty EE , 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
12
Hochberg MC . Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus[J]. Arthritis Rheum, 1997, 40 (9): 1725.
13
Dhariwal NK , Lynde GC . Update in the management of patients with preeclampsia[J]. Anesthesiol Clin, 2017, 35 (1): 95- 106.

doi: 10.1016/j.anclin.2016.09.009
14
Mendel A , Bernatsky SB , Hanly JG , et al. Low aspirin use and high prevalence of pre-eclampsia risk factors among pregnant women in a multinational SLE inception cohort[J]. Ann Rheum Dis, 2019, 78 (7): 1010- 1012.

doi: 10.1136/annrheumdis-2018-214434
15
Palmsten K , Simard JF , Chambers CD , et al. Medication use among pregnant women with systemic lupus erythematosus and general population comparators[J]. Rheumatology (Oxford), 2017, 56 (4): 561- 569.
16
Moroni G , Doria A , Giglio E , et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study[J]. J Autoimmun, 2016, 74, 6- 12.

doi: 10.1016/j.jaut.2016.07.010
17
ACOG committee opinion No. 743 summary: Low-dose aspirin use during pregnancy[J]. Obstet Gynecol, 2018, 132(1): 254-256.
18
LeFevre ML . Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. preventive services task force recommendation statement[J]. Ann Intern Med, 2014, 161 (11): 819- 826.

doi: 10.7326/M14-1884
19
Tani C , Zucchi D , Haase I , et al. Impact of low-dose acetylsalicylic acid on pregnancy outcome in systemic lupus erythematosus: Results from a multicentre study[J]. Lupus Sci Med, 2022, 9 (1): e000714.

doi: 10.1136/lupus-2022-000714
20
Zhang N , Zhang HX , Li YW , et al. Benefits of hydroxychloroquine combined with low-dose aspirin on pregnancy outcomes and serum cytokines in pregnant women with systemic lupus erythematosus[J]. Drugs R D, 2023, 23 (1): 35- 42.

doi: 10.1007/s40268-022-00408-0
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ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
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Email： xbbjb2@bjmu.edu.cn

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