Buyon J P, Winchester R J, Slade S G, Arnett F, Copel J, Friedman D, Lockshin M D
Department of Medicine, New York University School of Medicine.
Arthritis Rheum. 1993 Sep;36(9):1263-73. doi: 10.1002/art.1780360911.
To identify the fine specificity patterns of maternal anti-SS-A/Ro and anti-SS-B/La antibodies that are associated with the birth of a child with transient or permanent manifestations of neonatal lupus syndromes, and to suggest a predictor algorithm for use in counseling.
Sera were obtained from 4 groups of mothers: 57 whose children had congenital heart block, 12 whose children had transient dermatologic or hepatic manifestations of neonatal lupus but no detectable cardiac involvement, 152 with systemic lupus erythematosus and related autoimmune diseases, who gave birth to healthy infants, and 30 with autoimmune diseases whose pregnancy resulted in miscarriage, fetal death, or early postpartum death unrelated to neonatal lupus. Antibodies to SS-A/Ro and SS-B/La were assessed by enzyme-linked immunosorbent assay (ELISA) and by sodium dodecyl sulfate (SDS)-immunoblot.
Anti-SS-A/Ro antibodies were identified by ELISA in 100%, 91%, 47%, and 43% of the mothers of infants with heart block, with transient neonatal lupus, healthy infants, and fetal death, respectively. High titers of anti-SS-A/Ro antibodies were present more often in mothers of children with cardiac disease or transient neonatal lupus than in either of the other 2 groups. Maternal antibodies to SS-B/La were detected by ELISA in 76% of the heart block group, 73% of the cutaneous neonatal lupus group, 15% of the group with healthy children, and 7% of the fetal death group. On SDS-immunoblot, sera from 91% of the heart block group mothers who had antibodies to SS-A/Ro but not to SS-B/La recognized at least 1 SS-A/Ro antigen, with significantly greater reactivity against the 52-kd component. In contrast, only 62% of the anti-SS-A/Ro positive, anti-SS-B/La negative responders in the healthy group recognized the 52-kd and/or the 60-kd component. Although there was no profile of anti-SS-A/Ro response unique to the mothers of children with heart block or cutaneous manifestations of neonatal lupus, only 1% of the healthy infants were born to mothers with antibodies directed to both the 52-kd SS-A/Ro and 48-kd SS-B/La antigens and not to the 60-kd SS-A/Ro antigen.
Women with antibodies to both SS-A/Ro and SS-B/La have an increased risk of giving birth to children with neonatal lupus, especially if the anti-SS-A/Ro response identifies the 52-kd component on SDS-immunoblot. Women whose sera contain only anti-SS-A/Ro antibodies in low titer and only recognize determinants that are altered by conditions of SDS-immunoblot have a low risk for giving birth to a child with neonatal lupus. Specific antibody profiles do not distinguish among the manifestations of the neonatal lupus syndromes.
确定与新生儿狼疮综合征短暂或永久性表现患儿出生相关的母亲抗SS - A/Ro和抗SS - B/La抗体的精细特异性模式，并提出一种用于咨询的预测算法。
从4组母亲中获取血清：57名母亲的孩子患有先天性心脏传导阻滞，12名母亲的孩子有新生儿狼疮的短暂皮肤或肝脏表现但未检测到心脏受累，152名患有系统性红斑狼疮及相关自身免疫性疾病且生下健康婴儿的母亲，以及30名患有自身免疫性疾病且妊娠导致流产、胎儿死亡或与新生儿狼疮无关的早期产后死亡的母亲。通过酶联免疫吸附测定（ELISA）和十二烷基硫酸钠（SDS）免疫印迹法评估抗SS - A/Ro和SS - B/La抗体。
ELISA法在患有心脏传导阻滞、短暂新生儿狼疮、健康婴儿及胎儿死亡的婴儿母亲中分别检测到抗SS - A/Ro抗体的比例为100%、91%、47%和43%。高滴度抗SS - A/Ro抗体在患有心脏病或短暂新生儿狼疮的孩子的母亲中比在其他两组中更常见。ELISA法在心脏传导阻滞组76%的母亲、皮肤型新生儿狼疮组73%的母亲、健康儿童组15%的母亲及胎儿死亡组7%的母亲中检测到母体抗SS - B/La抗体。在SDS免疫印迹中，91%有抗SS - A/Ro但无抗SS - B/La抗体的心脏传导阻滞组母亲的血清识别至少1种SS - A/Ro抗原，对52 - kd成分的反应性明显更高。相比之下，健康组中抗SS - A/Ro阳性、抗SS - B/La阴性反应者中只有62%识别52 - kd和/或60 - kd成分。虽然没有针对患有心脏传导阻滞或新生儿狼疮皮肤表现的孩子的母亲所特有的抗SS - A/Ro反应谱，但只有1%的健康婴儿是由针对52 - kd SS - A/Ro和48 - kd SS - B/La抗原而不针对60 - kd SS - A/Ro抗原的抗体的母亲所生。
同时具有抗SS - A/Ro和抗SS - B/La抗体的女性生育患有新生儿狼疮孩子的风险增加，特别是如果抗SS - A/Ro反应在SDS免疫印迹中识别出52 - kd成分。血清中仅含有低滴度抗SS - A/Ro抗体且仅识别因SDS免疫印迹条件而改变的决定簇的女性生育患有新生儿狼疮孩子的风险较低。特定抗体谱不能区分新生儿狼疮综合征的不同表现。
