台灣全身性紅斑狼瘡婦女懷孕前就醫狀況之描述性分析

Descriptive Analysis of Medical Utilizations before Pregnancy with Systemic Lupus Erythematosus Women in Taiwan

10.6647/CN.201803_25(1).0005

葉純宜(Chun-Yi Yeh)

全身性紅斑狼瘡 ； 懷孕 ； 就醫狀況 ； Systemic Lupus Erythematosus ； Pregnancy ； Medical Utilizations

彰化護理

25卷1期（2018 / 03 / 01）

18 - 25

繁體中文

背景：懷孕時機對紅斑狼瘡婦女來說非常重要，許多專家建議應於病情穩定達六個月以上計量懷孕，以降低自身疾病發作並促進好的妊娠結果。因此懷孕前疾病穩定性是非常重要的。目的:本研究希望透過健保資料分析患者懷孕前就醫概況，了解懷孕前疾病穩定性。方法：以全民健何資料，採回溯性方法以ICD-9:710.0為研究對象，20~40歲至少2(含)次產檢者，回溯第一次產檢前180天之門診、急診、住院及有無接受急性發作治療就醫紀錄，以SAS 9.4統計軟體進行資料處理與分析。結果：3207人次有2次(含)以上產檢，平均年齡30.4歲，前180天平均門診21.35次，急診0.53次、住院0.44次、類固醇脈衝治療89人次(2.78%)、環磷醯胺治療97人次(3.02%)、血漿置換12人次(0.37%)，170人次(5.30%)曾接受至少1種急性發作治療。結論：高達38.14%懷孕前曾住院或急診就醫，病情不穩定之象徵，高風險群不適合懷孕，容易造成病情不穩定與不良妊娠結果，醫療團隊應告知患者懷孕的風險，並加強計畫性懷孕衛教，讓患者做好懷孕規劃與避孕措施。

Objective: The objective of this paper is to evaluate medical utilizations before pregnancy in systemic lupus erythematosus (SLE) patients. Method: Through a retrospective population-based study (NHIRD), we used ICD-9: 710.0, ≧ 2 times prenatal care, 20~40 age, outpatient, emergency, hospitalization and flare up treatment record of 180 days before the first prenatal care. Result: The average age of 30.4 years (n=3,207), outpatient 21.35 times, emergency 0.53 times, hospitalized 0.44 times, Methylprednisolone pulse therapy 89 patients (2.78%), Cyclophosphamide treatment of 97 patients (3.02%), plasmapheresis 12 patients (0.37%), 170(5.30%) had ≧ 1 flare up treatment. Conclusion: A high incidence of hospitalized or emergency medical treatment before pregnancy in SLE women, easily lead to unstable conditions and adverse pregnancy outcomes. Guiding the risk of pregnancy and planned pregnancy is very important. To enable patients to make pregnancy planning and contraception.

1. Cervera, R.,Rúa-Figueroa, I.,Gil-Aguado, A.,Sabio, J. M.,Pallarés, L.vHernández-Pastor, L. J.,Iglesias, M.(2013).Direct Cost of Management and Treatment of Active Systemie Lupus Erythematosus and its Flares in Spain: The Lucie Study.Revista Clinica Española (English Edition),213(3),127-137.
2. Clarke, A. E.,Urowitz, M. B.,Monga, N.,Hanly, J. G.(2015).Costs associated with severe and nonsevere Systemic Lupus Erythematosus in Canada.Arthritis Care & Research,67(3),431-436.
3. Clowse, M. E.,Chakravarty, E.,Costenbader, K. H.,Chambers, C.,Michaud, K.(2012).Effects of infertility, pregnancy loss, and patient concerns on family size of women with Rheumatoid Arthritis and Systemic Lupus Erythematosus.Arthritis Care & Research,64,668-674.
4. de Jesus, G. R.,Mendoza-Pinto, C.,De Jesus, N. R.,Dos Santos, F. C.,Klumb, E. M.,Carrasco, M. G.,Levy, R. A.(2015).Understanding and managing pregnancy in patients with Lupus.Autoimmune Dis,2015,1-18.
5. Hickman, R. A.,Gordon, C.(2011).Causes and management of infertility in Systemic Lupus Erythematosus.Rheumatology,50(9),1551-1558.
6. Jais, X.,Launay, D.,Yaici, A.,Le Pavec, J.,Tchérakian, C.,Sitbon, O.,Humbert, M(2008).Immunosuppressive therapy in lupus‐and mixed connective tissue disease–associated pulmonary arterial hypertension: a retrospective analysis of twenty‐three cases.Arthritis & Rheumatism,58(2),521-531.
7. Ko, H. S.,Ahn, H. Y.,Jang, D. G.,Choi, S.-K.,Park, Y.-G.,Park, I. Y.,Shin, J. C.(2011).Pregnancy outcomes and appropriate timing of pregnancy in 183 pregnancies in korean patients with SLE.International Journal Of Medical Sciences,8(7),577-583.
8. Kronbichler, A.,Brezina, B.,Quintana, L. F.,Jayne, D. R.(2016).Efficacy of plasma exchange and immunoadsorption in systemic lupus erythematosus and antiphospholipid syndrome: A Systematic Review.Autoimmunity Reviews,15(1),38-49.
9. Kwok, L.,Tam, L.,Zhu, T.,Leung, Y.,Li, E.(2011).Predictors of maternal and fetal outcomes in pregnancies of patients with Systemic Lupus Erythematosus.Lupus,20(8),829-836.
10. Lee, Y.,Woo, J.,Choi, S.,Ji, J.,Song, G.(2010).Induction and maintenance therapy for lupus nephritis: a systematic review and meta-analysis.Lupus,19(6),703-710.
11. Mcelhone, K.,Abbott, J.,Gray, J.,Williams, A.,Teh, L.(2010).Patient perspective of systemic lupus erythematosus in relation to health-related quality of life concepts. a qualitative study.Lupus,19(14),1-8.
12. Mok, C. C.,Yap, D. Y.,Navarra, S. V.,Liu, Z. H.,Zhao, M. H.,Lu, L.,Lapid, E. A.(2013).Overview of lupus nephritis management guidelines and perspective from Asia.International Journal Of Rheumatic Diseases,16(6),625-636.
13. Mokbel, A.,Geilan, A. M.,Aboelgheit, S.(2013).Could women with systemic lupus erythematosus (sle) have successful pregnancy outcomes? prospective observational study.The Egyptian Rheumatologist,35(3),133-139.
14. Petri, M.,Orbai, A. M.,Alarcón, G. S.,Gordon, C.,Merrill, J. T.,Fortin, P. R.,Nived, O.(2012).Derivation and validation of the systemic lupus international collaborating clinics classification criteria for Systemic Lupus Erythematosus.Arthritis & Rheumatism,64(8),2677-2686.
15. Van Niekerk, E. C.,Siebert, I.,Kruger, T. F.(2013).An evidence-based approach to recurrent pregnancy loss.South African Journal Of Obstetrics And Gynaecology,19(3),61-65.
16. Yazdany, J.,Trupin, L.,Kaiser, R.,Schmajuk, G.,Gillis, J. Z.,Chakravarty, E.,Schwarz, E. B.(2011).Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality?.Arthritis Care & Research,63(3),358-365.
17. Yeh, K.-W.,Yu, C.-H.,Chan, P.-C.,Horng, J.-T.,Huang, J.-L.(2013).Burden of systemic lupus erythematosus in taiwan: a population-based survey.Rheumatology International,33(7),1805-1811.