Medicine, NYU School of Medicine, New York, New York, United States
Medicine, NYU School of Medicine, New York, New York, United States.
Ann Rheum Dis. 2020 Feb;79(2):217-224. doi: 10.1136/annrheumdis-2019-215900. Epub 2019 Oct 31.
Cardiac manifestations of neonatal lupus (NL) have been associated with significant morbidity and mortality; however, there is minimal information on long-term outcomes of affected individuals. This study was initiated to evaluate the presence of and the risk factors associated with cardiac dysfunction in NL after birth in multiple age groups to improve counselling, to further understand pathogenesis and to provide potential preventative strategies.
Echocardiogram reports were evaluated in 239 individuals with cardiac NL: 143 from age 0-1 year, 176 from age >1-17 years and 64 from age >17 years. Logistic regression analyses evaluated associations of cardiac dysfunction at each age group with demographic, fetal and postnatal factors, using imputation to address missing data.
Cardiac dysfunction was identified in 22.4% at age 0-1 year, 14.8% at age >1-17 years and 28.1% at age >17 years. Dysfunction in various age groups was significantly associated with male sex, black race, lower fetal heart rates, fetal extranodal cardiac disease and length of time paced. In 106 children with echocardiograms at ages 0-1 year and >1-17 years, 43.8% with dysfunction at age 0-1 year were also affected at age >1-17 years, while the others reverted to normal. Of children without dysfunction at age 0-1 year, 8.9% developed new dysfunction between ages >1 and 17 years. Among 34 with echocardiograms at ages >1-17 years and >17 years, 6.5% with normal function at age >1-17 years developed dysfunction in adulthood.
Risk factors in fetal life can influence cardiac morbidity into adulthood.Although limited by a small number of cases, cardiac dysfunction in the first year often normalises by later childhood. New-onset dysfunction, although rare, can occur de novo after the first year.
新生儿狼疮（NL）的心脏表现与显著的发病率和死亡率相关；然而，关于受影响个体的长期结局的信息很少。本研究旨在评估多个年龄段 NL 出生后心脏功能障碍的存在和相关危险因素，以改善咨询，进一步了解发病机制并提供潜在的预防策略。
评估了 239 名心脏 NL 患者的超声心动图报告：143 名年龄 0-1 岁，176 名年龄>1-17 岁，64 名年龄>17 岁。使用缺失值插补进行逻辑回归分析，评估每个年龄组的心脏功能障碍与人口统计学、胎儿和产后因素的关联。
0-1 岁年龄组有 22.4%的患者存在心脏功能障碍，>1-17 岁年龄组为 14.8%，>17 岁年龄组为 28.1%。不同年龄组的功能障碍与男性、黑种人、较低的胎儿心率、胎儿结外心脏疾病和起搏时间有关。在 106 名年龄 0-1 岁和>1-17 岁进行超声心动图检查的儿童中，43.8%在 0-1 岁时存在功能障碍的儿童在>1-17 岁时也受到影响，而其他儿童恢复正常。在 0-1 岁时无功能障碍的儿童中，8.9%在>1 至 17 岁之间出现新的功能障碍。在 34 名年龄>1-17 岁和>17 岁进行超声心动图检查的儿童中，6.5%在>1-17 岁时功能正常的儿童在成年后出现功能障碍。
胎儿期的危险因素会影响成年后的心脏发病率。尽管病例数量有限，但在儿童后期，第一年的心脏功能障碍通常会恢复正常。虽然罕见，但在第一年之后可能会出现新的功能障碍。
