Sonesson Sven-Erik, Salomonsson Stina, Jacobsson Lilly-Ann, Bremme Katarina, Wahren-Herlenius Marie
Karolinska Institutet, Stockholm, Sweden.
Arthritis Rheum. 2004 Apr;50(4):1253-61. doi: 10.1002/art.20126.
To prospectively investigate the development of fetal heart block in anti-SSA/Ro 52-kd-positive women, and to evaluate the usefulness of serial Doppler echocardiography in detecting early signs of congenital heart block.
Twenty-four women with anti-SSA/Ro 52-kd antibodies and consequently increased risk for fetal heart block were followed up weekly, between 18 and 24 weeks of gestation, with two Doppler echocardiographic methods designed to estimate the time delay between hemodynamic events caused by atrial and ventricular depolarizations. Two hundred eighty-four women with normal pregnancies served as controls. Anti-Ro 52-kd, anti-Ro 60-kd, and anti-La antibodies were investigated by immunoblotting and enzyme-linked immunosorbent assay using recombinant proteins.
In anti-Ro 52-kd-positive women, fetal atrioventricular (AV) time intervals were longer and heart rates were slightly lower compared with those in controls. Eight of 24 fetuses had signs of first-degree block. One of these fetuses had progression to complete block, and another showed recovery from second-degree block to first-degree block with betamethasone treatment. In the remaining 6 fetuses, spontaneous normalization occurred before or shortly after birth. Fetuses with normal AV time intervals at 18-24 weeks had normal electrocardiographic results at birth.
Anti-Ro 52-kd-positive pregnant women frequently carry fetuses with Doppler echocardiographic signs of first-degree AV block. These blocks revert spontaneously in the majority of fetuses, but progression to a more severe degree of block may occur in some. Serial Doppler echocardiographic measurement of AV time intervals is suggested as a useful method for surveillance of these high-risk pregnancies.
前瞻性研究抗SSA/Ro 52-kd抗体阳性女性胎儿心脏传导阻滞的发生情况，并评估连续多普勒超声心动图在检测先天性心脏传导阻滞早期征象中的作用。
24例抗SSA/Ro 52-kd抗体阳性且胎儿心脏传导阻滞风险增加的女性，在妊娠18至24周期间每周进行随访，采用两种多普勒超声心动图方法评估心房和心室去极化引起的血流动力学事件之间的时间延迟。284例正常妊娠女性作为对照。使用重组蛋白通过免疫印迹法和酶联免疫吸附测定法检测抗Ro 52-kd、抗Ro 60-kd和抗La抗体。
与对照组相比，抗Ro 52-kd抗体阳性女性胎儿的房室（AV）时间间期更长，心率略低。24例胎儿中有8例有一度传导阻滞的征象。其中1例胎儿进展为完全性传导阻滞，另一例在倍他米松治疗后从二度传导阻滞恢复为一度传导阻滞。其余6例胎儿在出生前或出生后不久自发恢复正常。在18至24周时AV时间间期正常的胎儿出生时心电图结果正常。
抗Ro 52-kd抗体阳性孕妇所怀胎儿常出现多普勒超声心动图一度房室传导阻滞征象。这些传导阻滞在大多数胎儿中可自发恢复，但部分胎儿可能进展为更严重的传导阻滞。建议连续多普勒超声心动图测量AV时间间期作为监测这些高危妊娠的有用方法。
