DeNoble Anna E, Kuller Jeffrey A, Rhee Eleanor J
Resident, Department of Obstetrics and Gynecology, Duke University, Durham, NC.
Professor, Department of Obstetrics and Gynecology, Duke University, Durham, NC.
Obstet Gynecol Surv. 2015 Aug;70(8):518-23. doi: 10.1097/OGX.0000000000000208.
Congenital atrioventricular block (CAVB) affects approximately 2% of fetuses of mothers with anti-Ro or anti-La antibodies, regardless of maternal rheumatologic symptoms. Anti-Ro and anti-La antibodies are antinuclear antibodies commonly found in autoimmune diseases. Congenital atrioventricular block is associated with a relatively high fetal morbidity and mortality, particularly more advanced degrees of block. There is significant controversy surrounding surveillance of anti-Ro/La-positive pregnancies and treatment of fetuses diagnosed with CAVB. Studies of dexamethasone in the treatment of CAVB have yielded conflicting results, with most suggesting only a limited potential benefit in first- and seconddegree CAVB and in cases complicated by fetal hydrops. Larger prospective studies are needed to further evaluate the efficacy of intravenous immunoglobulin in the treatment of CAVB and of intravenous immunoglobulin and hydroxychloroquine in the prevention of CAVB in fetuses of at-risk mothers. Surveillance and treatment regimens should be determined on a case-by-case basis, taking into consideration the degree of CAVB, costs, and potential adverse effects of treatment.
先天性房室传导阻滞（CAVB）影响约2%有抗Ro或抗La抗体母亲的胎儿，无论母亲是否有风湿症状。抗Ro和抗La抗体是自身免疫性疾病中常见的抗核抗体。先天性房室传导阻滞与相对较高的胎儿发病率和死亡率相关，尤其是更严重程度的阻滞。关于抗Ro/La阳性妊娠的监测以及诊断为CAVB的胎儿的治疗存在重大争议。地塞米松治疗CAVB的研究结果相互矛盾，大多数研究表明，在一度和二度CAVB以及并发胎儿水肿的病例中，潜在益处有限。需要更大规模的前瞻性研究来进一步评估静脉注射免疫球蛋白治疗CAVB的疗效，以及静脉注射免疫球蛋白和羟氯喹预防高危母亲胎儿发生CAVB的疗效。应根据具体情况确定监测和治疗方案，同时考虑CAVB的程度、成本和治疗的潜在不良反应。
