胎儿心脏超声检查在抗SSA/Ro-SSB/La抗体阳性妊娠管理中的应用  

Application of fetal echocardiography in prenatal management of fetuses with positive maternal anti-SSA/Ro-SSB/La antibodies

作　　者：武玺宁 欧阳云淑 张一休 孟华 徐钟慧 张培培 吕珂 Wu Xining;Ouyang Yunshu;Zhang Yixiu;Meng Hua;Xu Zhonghui;Zhang Peipei;Lyu Ke(Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院超声医学科,100730

出　　处：《中华医学超声杂志（电子版）》2023年第10期1056-1060,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：中央高水平医院临床科研专项(2022-PUMCH-A-090);2019年度北京协和医院青年基金(pumch201911591)。

摘　　要：目的探讨超声评估胎儿心脏在母体抗SSA/Ro-SSB/La抗体阳性妊娠产前管理中的应用。方法前瞻性纳入2021年12月至2022年9月于北京协和医院就诊、抗SSA/Ro-SSB/La抗体阳性的孕妇,应用二维、M型和频谱多普勒超声评估胎儿心脏,观察心脏结构和房室壁、瓣环以及心肌回声,同时在五腔心切面测量胎儿房室传导时间,并随访妊娠结局。结果共纳入38例孕妇,其中8例原发性干燥综合征、13例系统性红斑狼疮、1例类风湿关节炎,16例临床诊断不明确。单胎37例,双绒毛膜囊双羊膜囊双胎1例,共计39例胎儿。12例(12/39,30.8%)胎儿合并心脏相关异常,包括10例(10/39,25.6%)左心室强回声,1例(1/39,2.6%)室间隔缺损,1例(1/39,2.6%)少量心包积液。2例(2/39,5.1%)胎儿诊断为I度房室传导阻滞,1例(1/39,2.6%)诊断为胎儿心律失常,Ⅱ度Ⅱ型房室传导阻滞(2:1传导),合并二尖瓣及三尖瓣瓣叶增厚及开放受限,收缩期三尖瓣可见少量反流。余36例(36/39,92.3%)胎儿心脏房室传导未见异常。1例因Ⅱ度房室传导阻滞孕中期引产,38例继续妊娠,胎儿平均出生体重为(2932.9±590.1)g。结论超声定期监测胎儿心脏可及早发现房室传导异常等免疫相关的心脏损伤,有助于母体抗SSA/Ro-SSB/La抗体阳性妊娠的产前管理。Objective To explore the application of fetal echocardiography in the prenatal management of fetuses with positive maternal anti-SSA/Ro-SSB/La antibodies.Methods We prospectively enrolled pregnant women with positive anti-SSA/Ro-SSB/La antibodies at Peking Union Medical College Hospital from December 2021 to September 2022.Two-dimensional,M-mode,and Doppler ultrasound were used to assessed fetal cardiac structure,and to observe the atrioventricular wall,annulus,and myocardial echo.Fetal atrioventricular interval was measured on the five-chamber plane.Pregnancy outcomes were followed up.Results A total of 38 pregnant women were enrolled in this study,including 8 with primary Sjögren syndrome,13 with systemic lupus erythematosus,1 with rheumatoid arthritis,and 16 with unclear clinical diagnosis.There were a total of 39 fetuses,including 37 singletons and a pair of twins with double chorionic sacs and double amniotic sacs.Twelve(12/39,30.8%)fetuses were complicated with heart-related abnormalities,including 10(10/39,25.6%)with the left ventricular hyperechogenic,1(1/39,2.6%)with ventricular septal defect,and 1(1/39,2.6%)with minimal pericardial effusion.Two fetuses(2/39,5.1%)were diagnosed with first-degree AVB,and 1(1/39,2.6%)with fetal arrhythmia,second-degree AVB(2:1),combined with mitral and tricuspid valve thickening and limited opening,and minimal tricuspid regurgitation during systole.The remaining 36 cases(36/39,92.3%)showed no abnormal fetal atrioventricular conduction.One woman chose to terminate pregnancy because of fetal second-degree AVB,and 38 women chose to continue pregnancy with a mean birth weight of(2932.9±590.1)g.Conclusion Regular monitoring of fetal echocardiography allows early detection of atrioventricular conduction abnormalities and facilitates the prenatal management of fetuses with positive maternal anti-SSA/Ro-SSB/La antibodies.

关 键 词：胎儿 抗SSA/Ro抗体 抗SSB/La抗体 超声心动图 房室传导阻滞 

分 类 号：R714.5[医药卫生—妇产科学]