抗Ro/SSA、抗La/SSB抗体阳性孕妇的新生儿结局分析  

Analysis of adverse neonatal outcomes in pregnant women with positive anti-Ro/SSA and anti-La/SSB antibodies

作　　者：张梦莹[1] 孙笑[1] Zhang Mengying;Sun Xiao(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院妇产科,北京100034

出　　处：《中华妇产科杂志》2023年第11期804-810,共7页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨孕妇抗Ro/干燥综合征抗原A(SSA)抗体和(或)抗La/干燥综合征抗原B(SSB)抗体阳性与新生儿不良结局的关系。方法本研究为回顾性研究,选取2017年1月至2022年6月于北京大学第一医院产前检查并分娩的抗Ro/SSA、抗La/SSB抗体阳性的136例孕妇的145例次分娩,根据是否发生新生儿不良结局将145例次分娩分为不良结局组(26例次)和无不良结局组(119例次),此外,根据发现抗Ro/SSA、抗La/SSB抗体阳性的时间将145例次分娩分为孕期阳性组(69例次)和孕前阳性组(76例次),分别比较不良结局组与无不良结局组、孕期阳性组与孕前阳性组孕妇的治疗、妊娠结局及母儿抗体水平。结果(1)136例抗Ro/SSA、抗La/SSB抗体阳性孕妇中,诊断为未分化结缔组织病者最多,占40.4%(55/136),其他依次为干燥综合征(25.0%,34/136)、系统性红斑狼疮(23.5%,32/136)、抗磷脂抗体综合征(6.6%,9/136)、特发性血小板减少性紫癜(1.5%,2/136),另有4例未行诊断。(2)41例妊娠期多次行抗体检测的孕妇中,妊娠早期与妊娠中期抗Ro/SSA、抗La/SSB抗体的水平分别比较,差异均无统计学意义(P均>0.05)。(3)不良结局组孕妇的抗Ro/SSA抗体高水平(>100 kU/L)比例、抗La/SSB抗体阳性孕妇的抗体水平及抗La/SSB抗体阳性率均高于无不良结局组,不良结局组的新生儿出生体重及活产率低于无不良结局组,分别比较,差异均有统计学意义(P均<0.05)。不良结局组与无不良结局组孕妇的抗Ro/SSA抗体水平、药物治疗(包括羟氯喹、糖皮质激素、丙种球蛋白)比例,胎儿生长受限(FGR)发生率、早产率及新生儿抗Ro/SSA、抗La/SSB抗体阳性率及抗体水平分别比较,差异均无统计学意义(P均>0.05)。(4)孕前阳性组孕妇抗Ro/SSA抗体水平,羟氯喹、糖皮质激素治疗比例,新生儿抗Ro/SSA抗体阳性率更高,而孕期阳性组FGR发生率、丙种球蛋白治疗率更高,分别比较,差异均有统计学意义(P均<0.05Objective To investigate the relationship between positive anti-Ro/Sjögren syndrome antigen type A(SSA)antibody and anti-La/Sjögren syndrome antigen type B(SSB)antibody in pregnant women and neonatal adverse outcomes.Methods This study was a retrospective study,and 145 deliveries of 136 anti-Ro/SSA and anti-La/SSB antibody positive pregnant women were selected who had prenatal examination and delivered in Peking University First Hospital from January 2017 to June 2022.According to whether adverse neonatal outcomes occurred,145 deliveries were divided into adverse outcome group(26 cases)and no adverse outcome group(119 cases).According to the time when anti-Ro/SSA and anti-La/SSB antibodies were found positive,145 deliveries were divided into the antibody positive during pregnancy group(69 cases)and the pre-pregnancy antibody positive group(76 cases).The pregnancy outcomes,treatment and maternal and infant antibody levels of pregnant women between the adverse outcome group and no adverse outcome group,between antibody positive during pregnancy group and the pre-pregnancy antibody positive group were compared.Results(1)Most of the pregnant women with positive anti-Ro/SSA and anti-La/SSB antibodies were diagnosed as undifferentiated connective tissue disease,accounting for 40.4%(55/136),followed by Sjogren′s syndrome(25.0%,34/136),systemic lupus erythematosus(23.5%,32/136),antiphospholipid antibody syndrome(6.6%,9/136),idiopathic thrombocytopenic purpura(1.5%,2/136),and 4 cases were not diagnosed.(2)The titers of anti-Ro/SSA and anti-La/SSB antibodies in the first trimester and the second trimester were compared,and there were no statistical significances(all P>0.05).(3)The proportion of high level anti-Ro/SSA antibody(>100 kU/L),positive level of anti-La/SSB antibody and positive rate of anti-La/SSB antibody in the adverse outcome group were higher than those in the no adverse outcome group,and the birth weight of newborns and live birth rate in the adverse outcome group were lower than that in the no adverse o

关 键 词：孕妇 抗体 抗核 自身抗原 核糖核蛋白类 心脏传导阻滞 妊娠结局 婴儿 新生 

分 类 号：R714.2[医药卫生—妇产科学]