Gerosa M, Cimaz R, Stramba-Badiale M, Goulene K, Meregalli E, Trespidi L, Acaia B, Cattaneo R, Tincani A, Motta M, Doria A, Zulian F, Milanesi O, Brucato A, Riboldi P, Meroni P L
Allergy, Clinical Immunology & Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Via Spagnoletto, 3, 20149 Milan, Italy.
Rheumatology (Oxford). 2007 Aug;46(8):1285-9. doi: 10.1093/rheumatology/kem073. Epub 2007 Apr 20.
To assess the prevalence of congenital heart block (CHB) and electrocardiographic (ECG) abnormalities in infants of anti-Ro/SSA-positive women.
Sixty anti-Ro-positive and 36 anti-Ro-negative patients were prospectively followed before/during pregnancy and underwent weekly fetal echocardiography from 18th to 26th weeks of gestational age. Infants' ECG and/or ECG-Holter were performed at 1, 3, 6 and 12 months. ECG of 200 consecutive neonates were used as a healthy control group.
One of 61 fetuses of anti-Ro-positive mothers developed CHB (20th week); another anti-Ro-positive baby developed second degree atrioventricular (AV) block (30th week). The prevalence of transient first degree AV block detected post-natally was significantly higher in the anti-Ro-positive group, in comparison with healthy controls (P = 0.002). No differences in corrected QT (QTc) interval prolongation prevalence (>/=440 ms) was observed between the anti-Ro-positive and -negative groups, but both were significantly higher than that of the control population (P < 0.001). ECG-Holter showed QTc prolongation in 59% of infants of anti-Ro-positive and in 60% of infants of anti-Ro-negative mothers. Holter QTc was >/=470 ms in four infants of anti-Ro-positive group and two of anti-Ro-negative group. Known acquired causes of QTc prolongation were excluded.
This prospective study confirms the low occurrence of CHB in newborns from anti-Ro-positive mothers. ECG abnormalities (first degree AV block and QTc interval prolongation) are frequent in infants of mothers with autoimmune diseases, independently of maternal disease, autoantibody profile and treatment during pregnancy.
评估抗Ro/SSA阳性女性所生婴儿先天性心脏传导阻滞（CHB）及心电图（ECG）异常的发生率。
对60例抗Ro阳性和36例抗Ro阴性患者在妊娠前/妊娠期间进行前瞻性随访，并在孕18至26周每周进行胎儿超声心动图检查。婴儿在1、3、6和12个月时进行心电图和/或动态心电图检查。选取200例连续新生儿的心电图作为健康对照组。
61例抗Ro阳性母亲所生胎儿中有1例在孕20周时发生CHB；另1例抗Ro阳性婴儿在孕30周时发生二度房室传导阻滞。与健康对照组相比，抗Ro阳性组出生后检测到的短暂一度房室传导阻滞发生率显著更高（P = 0.002）。抗Ro阳性组和阴性组之间校正QT（QTc）间期延长发生率（≥440毫秒）无差异，但均显著高于对照组人群（P < 0.001）。动态心电图显示，抗Ro阳性母亲所生婴儿中有59%出现QTc延长，抗Ro阴性母亲所生婴儿中有60%出现QTc延长。抗Ro阳性组有4例婴儿、抗Ro阴性组有2例婴儿的动态心电图QTc≥470毫秒。排除了已知的QTc延长的后天性原因。
这项前瞻性研究证实了抗Ro阳性母亲所生新生儿中CHB发生率较低。自身免疫性疾病母亲所生婴儿中，心电图异常（一度房室传导阻滞和QTc间期延长）很常见，与母亲疾病、自身抗体谱及孕期治疗无关。
