全身性紅斑狼瘡患者在腎移植後懷孕之病例報告

Pregnancy after Renal Transplant in a Patient with Systemic Lupus Erythematosus: A Case Report

罹患全身性紅斑狼瘡的女性，若病情控制良好，與正常女性一樣，有一樣正常的懷孕成功率，唯有在病情控制不好，例如腎炎導致末期腎衰竭，其懷孕的成功率會大為降低。而，接受腎臟移植的生育年齡女性，如果移植腎的功能正常，則其懷孕的成功率可與正常人類似。腎臟移植之全身性紅斑狼瘡育齡女性，若上述二條件均是，其懷孕率可與正常人一般。雖無懷孕成功率的問題，但她們的懷孕仍面臨許多問題。本案例為一名二十九歲的己婚女性，在十六歲時被診斷出全身性紅班狼瘡，未定期追蹤治療。二十歲時，因生產後狼瘡腎炎發生而導致尿毒症，而開始接受血液透析(hemodialysis)治療。二十五歲時，在本院接受右側腎臟移植手術，移植8 個月後懷孕。懷孕期間，曾發生肺炎合併左側肋膜積水，經抗生素治療後而改善。在懷孕37 週時，經剖腹產下一名，apgar score: 9’-10’，出生體重為2570gm，身長為47.5cm 的正常女嬰。案例目前仍繼續在本院婦產科、外科及風濕免疫科門診持續追蹤，移植腎臟功能良好，全身性紅斑狼瘡病情未活躍；女兒目前2 歲半多，也定期在小兒科門診做兒童健康檢查，定期施打疫苗注射，發育正常。本文希望藉由此案例報告討論，傳達接受腎臟移植後而懷孕的全身性紅斑狼瘡孕婦，在一個安全的環境下，仍有很大的機會獲得一個健康的新生兒。這需在外科、過敏免疫風濕科及婦產科等組合的醫療團隊，共同努力下才能完成這任務。

End stage renal disease is one of the severe organ complications for the systemic lupus erythematosus (SLE) and usually needs dialysis and/or transplant. A well controlled SLE lady in reproductive age not only has the chance of same graft and patient survival in comparison with the other transplant patients, she can also bear a healthy baby and safe delivery. However, she has to go along with several problems during pregnancy. This is a 29 year old lady who sustained SLE at the age of 16 and received hemodialysis at 20 because of ESRD. Fortunately, she was offered an excellent kidney by her younger brother at 25 and pregnancy was detected only eight months after transplantation. During the child bearing period, she was quite well except an episode of pneumonia and pleural effusion. At 37th gestational age, the baby was borne through Caesarian section (CS). The baby was healthy with a normal activity and growth percentile. Now both mother and child ( > 2 years old) are in healthy condition and are followed up at transplantation, immunology, obstetric, and pediatric clinics regularly. The aim of this paper is to share our team-work experience on a transplanted SLE mother during pregnancy and peri-natal period with the readers. Hopefully, it is helpful for the management of transplanted SLE patients in such an uncommon scenario.