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2016-12-25 1.为复发性流产（习惯性流产）患者提供咨询服务，教育等。2.反复移植不着床，妊娠并发肾炎，高血压，狼疮，子痫前期，反复生化妊娠等疾病提供文章，教育及服务。 翻译:北医三院刘湘源 (liu-xiangyuan@263.net) 发布：熊丽桂 摘要：目的：对自身免疫性先天性心脏传导阻滞的治疗，目前无标准的治疗指南，我们进行了一项前瞻性队列研究，评价联合治疗方案对自身抗体相关的先天性心脏传导阻滞的益处、安全性和有限性。 方法：从2009年到2014年，我们对抗SSA和或抗SSB抗体阳性的12例孕妇进行了前瞻性研究。治疗方案包括：发现CHB后，每周一次做血浆置换，每2周一次免疫球蛋白冲击，每日用一次4mg地塞米松，直到分娩，在出生后不久的新生儿使用IVIG。 结果：发现CHB时，胎儿出现2度和3度房室传导阻滞者均为6例。经过治疗后，2度房室传导阻滞胎儿中，有2例转化为1度房室传导阻滞，1例转化为正常传导，另外3例在整个孕期稳定。所有6例3度房室传导阻滞在孕期稳定，在出生时得到证实。出生时为1度房室传导、正常窦性心律和2度房室传导阻滞的患儿，平均（37.6±19.6）个月后均稳定。平均随访（29±19.8）个月期间，6例3度房室传导阻滞的婴儿中，有3例放置了起搏器。 结论:联合治疗似乎对2度房室传导阻滞是有效安全的，而对3度房室传导阻滞的有效性有待于进一步研究。 附原文：Abstract OBJECTIVES: At the moment there are no standard guidelines for the treatment of autoimmune congenital heart block (CHB). We set out to carry out a prospective cohort study to evaluate the benefits, limits, and safety of a combined therapy protocol to treat antibody-related CHB. METHODS:Twelve consecutive pregnant patients positive to anti-SSA/Ro ± anti-SSB/La antibodies in whom CHB was detected were prospectively evaluated from 2009 to 2014. The treatment protocol consisted of: weekly plasmapheresis, fortnightly intravenous immunoglobulins (IVIG), and daily 4 mg betamethasone from CHB detection until delivery; IVIG was administered to the neonates soon after birth.RESULTS:At the time CHB was detected, six of the foetuses presented atrioventricular blocks of 2(nd) degree type and six of 3(rd) degree type. Two of the foetuses with a 2(nd) degree block reverted to a 1st degree block and one to a normal atrioventricular conduction. The condition was stable throughout the pregnancy in the other three cases of 2(nd) degree block. All six 3(rd) degree blocks were stable during pregnancy and confirmed at birth. After a mean of 37.6 months ± 19.6 SD post-birth, the infants with 1st, normal sinus rhythm, and 2(nd) degree blocks at birth were all found to be stable. During the follow-up (29 months ± 19.8 SD), pacemakers were implanted in three of the six infants with 3(rd) degree blocks. CONCLUSIONS: This combined therapy seems to be effective and safe in treating 2(nd) degree CHB, while its efficacy in treating 3rd degree CHB remains to be established. 引自：Ruffatti A, Cerutti A, Favaro M, Del Ross T, Calligaro A, Hoxha A, Marson P, Leoni L, Milanesi O.Plasmapheresis, intravenous immunoglobulins and bethametasone - a combined protocol to treat autoimmune congenital heart block: a prospective cohort study. Clin Exp Rheumatol. 2016 Jul-Aug;34(4):706-13. Epub 2016 Jun 22. |
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