Lazzerini Pietro Enea, Acampa Maurizio, Guideri Francesca, Capecchi Pier Leopoldo, Campanella Valeria, Morozzi Gabriella, Galeazzi Mauro, Marcolongo Roberto, Laghi-Pasini Franco
University of Siena, Siena, Italy.
Arthritis Rheum. 2004 Apr;50(4):1248-52. doi: 10.1002/art.20130.
Newborns of mothers positive for anti-Ro/SSA autoantibodies may develop a series of electrocardiographic (EKG) disturbances. Prolongation of the corrected QT (QTc) interval was recently reported in a significant proportion of children with maternally acquired anti-Ro/SSA antibodies, with a concomitant disappearance of EKG abnormalities and acquired maternal autoantibodies during the first year, suggesting a direct, reversible electrophysiologic effect of anti-Ro/SSA antibodies on the ventricular repolarization. On this basis, we investigated whether these antibodies may also affect cardiac repolarization in anti-Ro/SSA-positive adult patients with connective tissue diseases.
Fifty-seven patients with connective tissue diseases were selected: 31 had anti-Ro/SSA antibodies and 26 did not (controls). In all subjects, we analyzed the QTc interval, heart rate variability, and signal-averaged high-resolution EKG recording.
Anti-Ro/SSA-positive patients showed a significant prolongation of the mean QTc interval compared with the controls (mean +/- SD 445 +/- 21 versus 419 +/- 17 msec; P = 0.000005). Eighteen of the 31 anti-Ro/SSA-positive patients (58%) and none of the 26 anti-Ro/SSA-negative patients had QTc values above the upper limit of normal (440 msec). Both groups had a reduction in heart rate variability, with a prevalence for the sympathetic nervous system and a high incidence of ventricular late potentials; these values were not significantly different between the 2 groups.
Adult patients with anti-Ro/SSA-positive connective tissue diseases showed a high prevalence of QTc interval prolongation. This feature, with the concomitant abnormalities in the autonomic tone and ventricular late excitability observed in all patients studied, suggests that anti-Ro/SSA-positive patients may have a particularly high risk of developing life-threatening arrhythmias.
抗Ro/SSA自身抗体呈阳性的母亲所生新生儿可能会出现一系列心电图（EKG）紊乱。最近有报告称，相当一部分母婴传播获得抗Ro/SSA抗体的儿童出现校正QT（QTc）间期延长，且在第一年期间EKG异常和获得性母体自身抗体同时消失，这表明抗Ro/SSA抗体对心室复极有直接、可逆的电生理作用。基于此，我们研究了这些抗体是否也会影响抗Ro/SSA阳性的结缔组织病成年患者的心脏复极。
选取57例结缔组织病患者：31例有抗Ro/SSA抗体，26例没有（对照组）。对所有受试者分析QTc间期、心率变异性和信号平均高分辨率EKG记录。
与对照组相比，抗Ro/SSA阳性患者的平均QTc间期显著延长（平均±标准差445±21对419±17毫秒；P = 0.000005）。31例抗Ro/SSA阳性患者中有18例（58%）QTc值高于正常上限（440毫秒），而26例抗Ro/SSA阴性患者中无一例如此。两组的心率变异性均降低，以交感神经系统为主，心室晚电位发生率高；两组之间这些值无显著差异。
抗Ro/SSA阳性的结缔组织病成年患者中QTc间期延长的患病率很高。这一特征，以及在所有研究患者中观察到的自主神经张力和心室晚期兴奋性的伴随异常，表明抗Ro/SSA阳性患者发生危及生命心律失常的风险可能特别高。
