The predictive value of anti-SS-A antibodies titration in pregnant women with fetal congenital heart block
The predictive value of anti-SS-A antibodies titration in pregnant women with fetal congenital heart block
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DOI：
10.1007/s10165-012-0704-z
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发表时间：
2013-07-01
影响因子：
2.2
通讯作者：
Murashima, Atsuko
中科院分区：
文献类型：
--
作者：
Anami, Ai;Fukushima, Kotaro;Murashima, Atsuko
目的胎儿先天性完全性心脏传导阻滞（CHB）是一种不可逆性心脏病，其病死率和致残率都很高。母体血清中的抗SS-A抗体参与了其发病机制，然而，抗体滴度的预测价值及其在预测这种并发症中的作用是有争议的。本研究的目的是确定母亲抗SS-A抗体对胎儿CHB发展的预测价值。方法回顾性分析189例抗SS-A抗体阳性的孕妇，其中包括17例胎儿CHB患者。结果通过分析受试者-操作特征（曲线下面积0.72）曲线，确定抗SS-A抗体滴度为1：32或更高。在多变量分析中，抗SS-A抗体滴度大于DID上限32倍或更多是胎儿CHB的危险因素（优势比27.77，95%置信区间（CI）1.91-21.02，P < 0.05）。107例抗SS-A抗体滴度≥ 1：32的患者中，65例（60.7%）口服激素治疗。其中，4例患者患有CHB（6.2%）。结论母血抗SS-A抗体效价≥ 1：32是胎儿CHB的独立危险因素。在这些患者中，产前给予泼尼松龙或倍他米松与胎儿CHB风险降低相关。
Objective Fetal congenital complete heart block (CHB) is irreversible and is associated with significant mortality and morbidity. Anti-SS-A antibodies in the maternal sera are involved in its pathogenesis; however, the predictive value of the antibody titer and its role in prediction of this complication are controversial. The aim of this study was to determine the predictive value of maternal anti-SS-A antibodies on the development of fetal CHB.Methods A retrospective chart review was performed for 189 cases of positive anti-SS-A antibodies determined by the double immunodiffusion (DID) method, and included 17 patients that developed fetal CHB. The relationship between the appearance of CHB and the anti-SS-A antibodies titer was examined.Results An anti-SS-A antibodies titer of 1:32 or higher was identified by analyzing the receiver-operating characteristics (area under curve 0.72) curve. An anti-SS-A antibodies titer of 32 or more times greater than the upper limit by DID was a risk factor for fetal CHB (odds ratio 27.77, 95 % confidence interval (CI) 1.91-21.02, P < 0.05) in the multivariate analysis. Among 107 cases of anti-SS-A antibodies titers of 1:32 or higher, 65 patients (60.7 %) were treated with oral steroids. Of these, four patients had CHB (6.2 %). This rate of CHB was significantly lower (P < 0.01) than the rate in patients not treated with steroids.Conclusion An anti-SS-A antibodies titer of 1:32 or higher in the maternal sera by DID was an independent risk factor for fetal CHB. In these patients, either antenatally administered prednisolone or betamethasone, was associated with a lower risk of fetal CHB.