二维斑点追踪成像评价抗SSA和抗SSB抗体阳性孕妇胎儿心功能及收缩非同步性

Evaluation of cardiac function and systolic dyssynchrony of fetuses exposed to maternal anti-SSA and anti-SSB antibodies using two-dimensional speckle tracking imaging

目的利用二维斑点追踪成像(2D-STI)技术评估暴露于母体自身免疫性抗体(抗SSA/Ro60、抗SSA/Ro52和抗SSB/La)的胎儿心功能和收缩非同步性。方法选取2018年7月至2020年11月就诊于内蒙古医科大学附属医院的孕前及中孕期自身免疫性抗体均为阳性的自身免疫性疾病(AD)孕妇18例(AD组)和正常产检的自身免疫性抗体阴性的健康孕妇34例(对照组)。收集两组孕妇中孕期一般临床资料、胎盘多普勒参数及常规胎儿超声心动图参数。2D-STI测量两组胎儿左、右心室的收缩期整体和局部纵向应变以及局部心肌应变达峰时间,胎儿双心室收缩期非同步性参数(2C-DYS,即左室游离壁及右室游离壁的纵向应变达峰时间差)和胎儿单一心室收缩期非同步性参数(1C-DYS,即室间隔与左室游离壁纵向应变达峰时间差)。结果两组间常规超声测量的胎儿左、右心室收缩及舒张功能参数差异无统计学意义(均P>0.05),2D-STI获得的胎儿心肌整体纵向应变及2C-DYS差异亦无统计学意义(均P>0.05),而AD组胎儿1C-DYS较对照组明显延长[28.50(13.50,39.25)ms比19.50(8.00,29.25)ms,P=0.042]。结论自身免疫性抗体阳性孕妇的胎儿左室收缩不同步时间延长,提示胎儿心脏传导系统存在亚临床损伤。

Objective To evaluate the cardiac function and systolic dyssynchrony of fetuses exposed to maternal autoimmune antibodies(anti-SSA/Ro60,anti-SSA/Ro52 and anti-SSB/La)by using two-dimensional speckle tracking imaging(2D-STI).Methods A total of 52 pregnant women with singleton pregnancy in the Affiliated Hospital of Inner Mongolia Medical University from July 2018 to November 2020 were selected.Eighteen fetuses of mothers with autoimmune antibodies were enrolled as autoimmune disease(AD)group and 34 fetuses of healthy mothers without antibodies were included as control group.Maternal baseline characteristics,fetoplacental Doppler parameters,and conventional echocardiographic data of two groups were prospectively collected.The systolic global and regional longitudinal strain of left and right ventricles(LV and RV)and the time to peak strain of regional myocardium were measured using 2D-STI.The differences in time to peak strain between the LV free wall and RV free wall(two-chamber dyssynchrony,2C-DYS)and between the septum and LV free wall(one-chamber dyssynchrony,1C-DYS)were also calculated.Results There were no significant differences between the two groups in conventional systolic and diastolic functional parameters for the LV and RV(all P>0.05).The myocardial deformation parameters and 2C-DYS obtained by 2D-STI showed no statistical differences between two groups(all P>0.05).However,1C-DYS was significantly more prolonged in the AD group than control group[28.50(13.50,39.25)ms vs 19.50(8.00,29.25)ms,P=0.042].Conclusions LV systolic mechanical dyssynchrony in fetuses of mothers with autoimmune antibodies suggests in-utero subclinical damage of the cardiac conduction system.