日本未熟児新生児学会雑誌　第22巻　第1号　44～48頁（2010年）

日本未熟児新生児学会雑誌　22(1)：44-48；2010　

受付日：平成21．03．31

受理日：平成21．06．10

抗リン脂質抗体陽性母体から出生し一過性の白質病変を認めた新生児例

Transient White Matter Lesion in a Neonate Born to a Mother with Antiphospholipid Antibody

群馬県立小児医療センター　新生児科

Department of Neonatology, Gunma Children’s Medical Center

丸山憲一・小泉武宣・藤生　徹・浦野博央・中島一恵・塩谷亜矢

Kenichi MARUYAMA，Takenobu KOIZUMI，Tohru FUJIU，Hiroo URANO，Kazue NAKAJIMA，Aya SHIOYA

Key Words：antiphospholipid antibody，brain，MRI，newborn infant，white matter

　抗リン脂質抗体は種々の神経疾患と関連している。今回，われわれは抗リン脂質抗体陽性母体から出生し，一過性の白質病変を認めた新生児例を経験したので報告する。症例は母親が抗リン脂質抗体陽性で2回自然流産歴のある男児。在胎34週5日，出生体重2,180g，Apgar score 1分後3点，5分後7点。新生児仮死にて当科入院。入院時，筋緊張軽度低下と血液凝固異常，頭部CTで大脳白質を中心としたlow densityと基底核の不明瞭化を認めた。日齢8の頭部MRIではT1，T2強調像で白質に斑状，小結節状の異常信号域を認めたが，日齢34の頭部MRIではFLAIR像で白質領域の信号強度の不均一を認めるのみであった。日齢43に入院依頼元へ逆搬送した。生後3カ月時の頭部MRIは正常で，6歳の時点で神経学的後遺症は認めなかった。本症例の白質病変の出現には母体血中もしくは出生前に児に移行した抗リン脂質抗体が関与している可能性があると考えられた。

　A neonate with transient white matter lesion who was born to a mother with antiphospholipid antibody is reported. A male baby was delivered with a birth weight of 2180g at 34 weeks and 5 days’ gestation. The Apgar scores were 3 and 7 at 1 and 5 minutes after birth, respectively. He was admitted to our hospital 2 hours after birth because of neonatal asphyxia. At admission, he had mild hypotonia and coagulopathy. Computed tomography scan of the brain at admission showed diffuse low density of the white matter. At 8 days of age, magnetic resonance imaging （MRI） of the brain revealed an area of abnormal signal in the white matter, consisting of patchy or nodular lesions with heterogeneous signal intensity, suggesting T1 and T2 elongation and shortening. The lesion of abnormal intensity had almost disappeared on MRI at 34 days of age, although FLAIR revealed slightly heterogeneous signal intensity remaining in the white matter. At 43 days of age, he was transferred back to the hospital where he was born. MRI findings of the brain were normal at 3 months of age, and he had no neurological sequelae at 6 years of age. Antiphospholipid antibodies in the maternal serum or prenatally transferred to the patient are thought to be associated with development of the white matter lesion.