日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 32(1): 19-25 (2016)
doi:10.9794/jspccs.32.19

原著原著

母体抗SS-A抗体陽性の先天性完全房室ブロックの胎児における子宮内胎児死亡の危険因子Risk Factors for Intrauterine Death in Fetuses with Congenital Complete Atrioventricular Block and Positive Maternal Anti-SS-A Antibodies

1国立成育医療研究センター循環器科Division of Cardiology, National Center for Child Health and Development ◇ Tokyo, Japan

2久留米大学小児科総合周産期母子センター新生児部門Maternal and Perinatal Medical Center, Kurume University School of Medicine ◇ Fukuoka, Japan

3筑波大学医学医療系小児内科Department of Child Health, Faculty of Medicine, University of Tsukuba ◇ Ibaraki, Japan

4国立成育医療研究センター母性内科Division of Maternal Medicine, National Center for Child Health and Development ◇ Tokyo, Japan

受付日:2015年7月2日Received: July 2, 2015
受理日:2015年10月13日Accepted: October 13, 2015
発行日:2016年1月1日Published: January 1, 2016
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背景:抗SS-A抗体陽性妊娠に限定した胎児先天性完全房室ブロック(CCAVB)の予後規定因子についての報告はほとんどなく,母体の膠原病症状や母体抗SS-A抗体価とCCAVBの胎児の予後の関連についても報告は少ない.本研究の目的は,母体抗SS-A抗体陽性のCCAVBの胎児における子宮内胎児死亡(IUFD)の危険因子を明らかにすることである.

方法:全国66施設で1996~2010年に娩出された母体抗SS-A抗体陽性のCCAVB胎児47例を,IUFD群(7例)とlive-birth群(40例)に分け,臨床データや各種検査値を後方視的に比較した.

結果:IUFD群では,live-birth群に比べ,診断時の胎児心拍数が55回/分未満であった症例が多く(57% vs 17%, p<0.05),経過中に胎児水腫を認める頻度が高く(71% vs 20%, p<0.05),さらに母体年齢が高かった.多変量解析では,胎児水腫と母体高年齢がIUFDの独立した危険因子であった.両群で母体膠原病の有症状率,母体抗SS-A抗体価,およびステロイドの経胎盤的投与率に有意差はなかった.

結論:母体抗SS-A抗体陽性のCCAVBの胎児では,胎児水腫と母体高年齢がIUFDの危険因子であり,胎児水腫について注意深く経過観察し,適切な娩出時期を検討する必要がある.

Background: There are few reports that focus specifically on the prognostic factors for fetal cases of congenital complete atrioventricular block (CCAVB) with positive maternal anti-SS-A antibodies, and the impact of maternal symptoms and anti-SS-A antibody levels on fetal prognosis remains unclear. The aim of this study was to elucidate the risk factors for intrauterine fetal death (IUFD) in fetuses with CCAVB and positive maternal anti-SS-A antibodies.

Method: We retrospectively analyzed 47 fetal cases of CCAVB born to mothers with positive anti-SS-A antibodies at 66 hospitals in Japan from 1996 to 2010. Clinical characteristics and measurements between the IUFD group (n=7) and the live-birth group (n=40) were compared.

Results: Cases of fetal heart rate <55 beats/minute at diagnosis of CCAVB (57% vs 17%, p<0.05) and development of hydrops fetalis during follow up (71% vs 20%, p<0.05) were more in the IUFD group than the live-birth group. Advanced maternal age was also associated with IUFD. Multivariate analysis showed that hydrops fetalis and advanced maternal age were independent risk factors for IUFD. There were no significant differences between the groups in the frequency of mothers with symptoms of connective tissue diseases, maternal anti-SS-A antibody levels, and the rate of transplacental administration of steroids.

Conclusion: Hydrops fetalis and advanced maternal age are independent risk factors for IUFD. Fetuses with CCAVB and positive maternal SS-A antibodies should be closely followed up for hydrops fetalis so that they can be delivered in a timely fashion.

Key words: anti-SS-A antibody; complete atrioventricular block; intrauterine fetal death; hydrops fetalis

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