北京大学学报(医学版) ›› 2023, Vol. 55 ›› Issue (6): 1053-1057. doi: 10.19723/j.issn.1671-167X.2023.06.015
李宇菲1,闫亚妮2,靳家扬1,李春1,*(),裴秋艳2,*()
Yu-fei LI1,Ya-ni YAN2,Jia-yang JIN1,Chun LI1,*(),Qiu-yan PEI2,*()
摘要:
目的: 探究合并胎儿心脏病变的抗干燥综合征相关抗原A(Sjögren’s-syndrome-related antigen A, SSA)抗体阳性孕妇的临床表现、实验室指征及药物特征。方法: 在2013年1月至2023年7月于北京大学人民医院就诊且最终确诊自身免疫病的孕妇中, 选择抗SSA抗体阳性且超声确诊胎儿心脏病变的患者作为病变组, 抗SSA抗体阳性且超声检查无胎儿心脏病变的患者作为对照组, 收集两组患者的临床、实验室及用药信息, 比较组间基线数据无差异后对其临床指标进行统计学分析。结果: 合并胎儿心脏病变的抗SSA抗体阳性患者共11例, 其中有先天性房室传导阻滞表现者共7例, 是最常见的胎儿心脏病变类型。病变组患者孕前确诊自身免疫病的比例显著低于对照组(P=0.032), 多因胎儿心脏病变首次进行相关免疫学检查。病变组患者孕期白细胞水平[(9.29±2.58)×109/L vs. (7.10±1.90)×109/L, t=3.052, P=0.004]、红细胞沉降率[49.50(48.00, 51.00) mm/h vs. 23.00(15.00, 30.25) mm/h, Z=-2.251, P=0.024]、IgA水平[3.46(2.30, 5.06) g/L vs. 2.13(1.77, 2.77) g/L, Z=-2.181, P=0.029]、抗核抗体(antinuclear antibody, ANA)滴度[1∶320(1∶160, 1∶320) vs. 1∶80(1∶40, 1∶160), Z=-3.022, P=0.003]显著高于对照组。组间孕期合并SSB抗体阳性的比例(37.5% vs. 7.7%, P=0.053)、羟氯喹使用剂量及起用时间差异均无统计学意义。病变组孕期使用激素的比例及剂量显著高于对照组(P<0.05), 其中孕早期两组间差异无统计学意义, 而孕中期、孕晚期病变组激素使用剂量显著高于对照组。结论: 胎儿心脏病变是一种罕见但与抗SSA抗体阳性高度相关的胎儿畸形, 孕期白细胞、红细胞沉降率、IgA水平及ANA滴度显著升高的患者胎儿心脏病变发生的风险更高。胎儿房室传导阻滞一旦发生便难以逆转, 因此, 预防和监测的重要性高于补救治疗。
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