Miyakata S, Takeuchi K, Yamaji K, Kanai Y, Tsuda H, Takasaki Y
Department of Rheumatology and Internal Medicine, Juntendo University School of Medicine, Bunkyo-ku, Tokyo.
Ryumachi. 2001 Aug;41(4):726-35.
Neonatal lupus erythematosus is characterized by transient lupus abnormalities, various systemic and hematological abnormalities, and congenital complete heart block (CCHB). It is well known that anti-SS-A/Ro antibody (52 kD/60 kD) and anti-SS-B/La antibody are associated with CCHB. This study was conducted to evaluate the effects of the removal of anti-SS-A/Ro antibody (52 kD/60 kD) and anti-SS-B/La antibody from plasma in pregnant women whose fetuses are at a high risk of developing CCHB.
MATERIALS & METHODS: Fifteen pregnant patients positive for anti-SS-A/Ro antibody and anti-SS-B/Laantibody were subjected weekly to double filtration plasmapheresis to remove both antibodies. Antibody titers were measured by double immunodiffusion (DID) and ELISA.
As a result, all women gave birth to live babies, but CCHB was recognized in one baby. No transient lupus abnormalities were recognized in any of the babies. Fourteen patients showed decreased antibody titers by ELISA during plasmapheresis. However, the patient who was delivered of a baby with CCHB showed an increase of antibody titers by ELISA while the DID method showed a decrease of antibody titers.
Our study suggested that plasmapheresis prevents CCHB associated with anti-SS-A/Ro and anti-SS-B/La antibody. Also, it is important to monitor the antibody titer regularly during the course of pregnancy, because it may increase due to worsening of the mother's primary disease.
新生儿红斑狼疮的特征为短暂性狼疮异常、各种全身和血液学异常以及先天性完全性心脏传导阻滞（CCHB）。众所周知，抗SS - A/Ro抗体（52 kD/60 kD）和抗SS - B/La抗体与CCHB相关。本研究旨在评估从胎儿有高风险发生CCHB的孕妇血浆中去除抗SS - A/Ro抗体（52 kD/60 kD）和抗SS - B/La抗体的效果。
15例抗SS - A/Ro抗体和抗SS - B/La抗体阳性的孕妇每周接受双重过滤血浆置换以去除这两种抗体。通过双向免疫扩散（DID）和酶联免疫吸附测定（ELISA）测量抗体滴度。
结果显示，所有女性均产下活婴，但有1例婴儿被诊断为CCHB。所有婴儿均未出现短暂性狼疮异常。14例患者在血浆置换期间ELISA检测显示抗体滴度下降。然而，产下患有CCHB婴儿的患者ELISA检测显示抗体滴度升高，而DID法显示抗体滴度下降。
我们的研究表明，血浆置换可预防与抗SS - A/Ro和抗SS - B/La抗体相关的CCHB。此外，在孕期定期监测抗体滴度很重要，因为其可能因母亲原发性疾病的恶化而升高。
