胎儿超声心动图特征与母体抗干燥综合征相关抗体关系  

Relationship between fetal echocardiography and maternal anti Sjogren's syndrome related antibodies

作　　者：何美情[1] 王娟[2] 彭健美 韩磊[1] 高燕华[1] 任媛[1] HE Mei-qing;WANG Juan;PENG Jian-mei;HAN Lei;GAO Yan-hua;REN Yuan(Ultrasound Diagnosis Center,Shaanxi Provincial People's Hospital,Xi'an 710061,China;Ultrasound Diagnosis Center,Second Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]陕西省人民医院超声诊断中心,陕西西安710061 [2]西安交通大学第二附属医院超声诊断中心,陕西西安710004

出　　处：《中国临床医学影像杂志》2020年第9期647-650,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨胎儿超声心动图特征与母体抗干燥综合征A(SSA)、抗SSB及抗SSA-52抗体之间的关系。方法:前瞻性分析2013年12月—2018年12月我院孕期检查中显示胎儿心房和瓣环超声回声增强的65例孕妇及胎儿资料。抽取孕妇静脉血进行可溶性核抗原抗体谱检测,比较不同阳性组合孕妇自身免疫性疾病检出情况、胎儿心脏病构成情况、胎儿超声心动图参数以及妊娠结局。结果:母体以SSA+SSB+为主(38.46%),其次为SSA+SSA-52+(26.15%)和SSA+SSB+SSA-52+(16.92%),系统性红斑狼疮(SLE)和原发性干燥综合征(PSS)孕妇以SSA+SSB+为主,分别占12.31%和21.54%,类风湿性关节炎(RA)孕妇以单独SSA+为主,占9.23%;母体SSA+、SSB+、SSA+SSB+和SSA+SSA-52+中胎儿均以窦性心动过缓为主,母体SSA+SSB+SSA-52+中胎儿以Ⅲ度AVB为主;不同ENA抗体谱检测结果胎儿二尖瓣口舒张晚期血流峰值速度(AMV)和二尖瓣口舒张早期血流峰值速度(EMV)/AMV比较,差异有统计学意义(P<0.05);9例单独SSA+孕妇中经过治疗后,3例胎儿出生后安装心脏起搏器,6例终止妊娠;3例单独SSB+孕妇中胎儿出生后未出现心脏异常;53例SSA+SSB+、SSB+SSA-52+及SSA+SSB+SSA-52+孕妇终止妊娠。结论:胎儿心房和瓣环超声回声增强对母体体内免疫性抗体异常表达存在一定提示作用,临床可据此早期及时对孕妇进行免疫性疾病筛查。Objective:To investigate the relationship between fetal echocardiography and maternal anti-Sjogren's syndrome A(SSA),anti-SSB and anti-SSA-52 antibodies.Methods:The data of 65 pregnant women and fetuses with enhanced echocardiography of fetal atria and annulus in our hospital from December 2013 to December 2018 were prospectively analyzed.Analysis of extractable nuclear antigen(ENA)antibody spectrum was conducted.Different positive combinations including the detection of pregnant women's autoimmune diseases,the constitution of fetal heart disease,the parameters of fetal echocardiography and the outcome of pregnancy were compared.Results:Combination of maternal ENA antibody was mainly SSA+SSB+(38.46%),followed by SSA+SSA-52+(26.15%)and SSB+SSA-52+(16.92%).SSA+SSB+was the main combination type for systemic lupus erythematosus(SLE)and primary Sjogren's syndrome(PSS),accounting for 12.31%and 21.54%,respectively.Single SSA+was the main combination type for rheumatoid arthritis(RA),accounted for 9.23%.The fetuses in the matern with SSA+,SSB+,SSA+SSB+and SSA+SSA-52+were mainly sinus bradycardia.The fetuses among matern with SSA+SSB+SSA-52+were mainly atrioventricular block(AVB degreeⅢ).There was significant difference between the peak velocity(AMV)in the late diastolic phase and the peak velocity(EMV)/AMV in the early diastolic phase(P<0.05)tested by different ENA antibody spectrum.Among the 9 pregnant women with SSA+,3 fetuses were implanted with cardiac pacemaker after birth and 6 terminated pregnancy.There was no fetal cardiac abnormality SSB+3 pregnant women after fetus birth.Fifty-three pregnant women with SSA+SSB+,SSB+SSA-52+and SSA+SSB+SSA-52+all terminated pregnancy.Conclusion:The ultrasonic echo enhancement of fetal atrium and annulus has some suggestive effect on the abnormal expression of immune antibody in the maternal body.Therefore,the early screening of immune diseases in pregnant women can be carried out in time.

关 键 词：干燥综合征 超声检查 产前 超声心动描记术 

分 类 号：R593.2[医药卫生—内科学] R714.5[医药卫生—临床医学]