免疫介导相关胎儿心脏异常的超声表现及妊娠结局

Ultrasonie presentation and pregnancy outcome of immune-mediated fetal cardiac anomalies

目的分析免疫介导相关胎儿心脏异常的产前超声心动图特征,为妊娠伴自身免疫性疾病的围产期管理提供依据.方法选取我院2016年1月至2021年7月确诊系统性自身免疫性疾病稳定期孕妇101例为对照组,另选取同期在我院首次发现胎儿心脏异常且其后检测母体自身抗体阳性的孕妇11例为暴露组,对以上两组胎儿进行产前及产后超声心动图评估,对比妊娠结局.结果暴露组11例中7例(7/11,63.64%)出现心脏器质性改变,主要表现为以心房为主的房室壁回声增强,8例(8/11,72.73%)出现以缓慢型心律失常为主的心脏节律改变,5例(5/11,45.45%)出现联合病变,5例(5/11,45.45%)胎儿活产预后良好.对照组101例均未见明显心脏结构畸形,8例(8/101,7.92%)出现轻度三尖瓣反流,3例(3/101,2.97%)早产,所有病例预后均良好.暴露组临床表现及预后均明显较对照组差,差异具有统计学意义(P<0.001).结论免疫介导相关胎儿心脏异常以心脏房室传导阻滞、心内膜及瓣膜病变为主要表现,通过对确诊及可疑自身免疫性疾病的孕妇进行超声心动图监测,尤其是通过对心脏AGV间期监测,可早期发现Ⅰ度房室传导阻滞并通过及时干预改善胎儿预后.

Objective To analyze the prenatal echocardiographic characteristics of immune mediated fetal heart abnor-malities,and to provide evidence for perinatal management of pregnancy with autoimmune diseases.Methods A total of 101 pregnant women diagnosed with systemic autoimmune diseases at stable stage from January 2016 to July 2021 were selected as the control group.In addition,11 pregnant women who first detected fetal heart abnormalities in our hospital during the same period and subsequently detected positive maternal autoantibodies were selected as the exposure group.Prenatal and postnatal echocardiography were performed to evaluate the fetal outcomes of the two groups.Results In the exposure group,7 of 11 cases(7/11,63.64%)showed organic changes in the heart,which was mainly manifested as enhanced echo of atrium wall and ventricular wall,with atrium as the main body,8 cases(8/11,72.73%)showed changes in cardiac rhythm mainly in brady-arrhythmia,5 cases(5/11,45.45%)showed combined lesions,and 5 cases(5/11,45.45%)fetal prognosis were good during live birth.In the control group,there were no obrious cardiac structural malformations,8 cases(8/101,7.92%)had mild tricuspid regurgitation,and 3 cases(3/101,2.97%)were premature.All the cases had good prognosis.The clinical manifestations and prognosis of the exposure group were significantly worse than that of the control group,and the differences were statitially significant(P<0.001).Conclusion The main manifestations of immune-mediated fetal cardiac abnormalities are atrioventricular block,endocardial and valvular lesions.Echocardiographic monitoring of pregnant women with confirmed and suspected autoimmune discascs,especially the A-V interval monitoring of the heart,can detect grade I atrioventricular block early and improve fetal prognosis through timely intervention.