CAJ | 학술논문

目的探讨产前超声发现胎儿侧脑室扩张的临床意义及预后. 方法研究对象为2007年8月至2010年8月因超声发现侧脑室扩张于南方医科大学南方医院妇产科遗传咨询门诊就诊的92例单胎妊娠孕妇,根据胎儿侧脑室宽度分为重度侧脑室扩张(≥15.0 mm,4例)和轻度侧脑室扩张(10.0～14.9 mm,88例),轻度侧脑室扩张组又分为A组(10.0～12.0 mm,50例)和B组(12.1～14.9 mm,38例).对相关临床资料进行回顾性分析,对宫内转归、新生儿出生后神经行为发育情况进行随访.统计方法采用x2检验(或Fisher精确概率法)、Bonfferoni方法校正、MannWhitney和Kruskal-Wallis检验. 结果轻度侧脑室扩张的A和B组及重度侧脑室扩张组胎儿合并其他系统发育异常(非孤立性侧脑室扩张)的发生率分别为18.0％(9/50),65.8％(25/38)和3/4(x2＝22.934,P=0.000),A、B两组比较差异有统计学意义(x2＝20.798,P=0.000)；胎儿合并染色体异常的发生率分别为4.0％(2/50),7.9％(3/38)和0/4(x2 =0.878,P=0.645).4例重度侧脑室扩张病例均终止妊娠,轻度侧脑室扩张病例继续妊娠的63例胎儿中(A和B组分别为48例和15例),B组官内转归较A组差(B组侧脑室扩张进展、稳定和缩小者分别为3、10和2例,A组分别为3、15和30例,Z=-3.317,P=0.001),A组中非孤立性侧脑室扩张胎儿宫内预后较孤立性侧脑室扩张者差(Z=-2.631,P=0.009).顺利娩出的62例新生儿在生后14d进行新生儿神经行为发育情况评估,A、B两组≥35分比例分别为93.8％(45/48)和71.4％(10/14),差异有统计学意义(Fisher精确概率法,P=0.040).婴儿出生后12个月(存活46例,A组35例,B组11例)采用贝利婴幼儿发展量表(Bayley scales of infant development,BSID)评估,评分显示A和B组运动发育指数差异有统计学意义(A组发育优秀、中等和低下者分别为8、26和1例,B组分别为1、7和3例,Z=-2.203,P＝0.043),但智力发育指数评分2组间差异无统计学意义.存活婴儿中20例行磁共振成像(magnetic resonance imaging,MRI)检查,45.0％(9例)侧脑室宽度缩小,50.0％(10例)侧脑室扩张持续存在,5.0％(1例)侧脑室扩张宽度增加.生后侧脑室扩张转归情况与BSID评分相关,侧脑室宽度缩小者较稳定和进展者预后好(P=0.033). 结论胎儿侧脑室扩张宽度为10.0～12.0 mm者预后较好.超声确诊的侧脑室扩张胎儿,建议进行相关病因学检查,必要时行MRI检查.对侧脑室轻度扩张胎儿应加强宫内及出生后随访. 目的探討產前超聲髮現胎兒側腦室擴張的臨床意義及預後. 方法研究對象為2007年8月至2010年8月因超聲髮現側腦室擴張于南方醫科大學南方醫院婦產科遺傳咨詢門診就診的92例單胎妊娠孕婦,根據胎兒側腦室寬度分為重度側腦室擴張(≥15.0 mm,4例)和輕度側腦室擴張(10.0～14.9 mm,88例),輕度側腦室擴張組又分為A組(10.0～12.0 mm,50例)和B組(12.1～14.9 mm,38例).對相關臨床資料進行迴顧性分析,對宮內轉歸、新生兒齣生後神經行為髮育情況進行隨訪.統計方法採用x2檢驗(或Fisher精確概率法)、Bonfferoni方法校正、MannWhitney和Kruskal-Wallis檢驗. 結果輕度側腦室擴張的A和B組及重度側腦室擴張組胎兒閤併其他繫統髮育異常(非孤立性側腦室擴張)的髮生率分彆為18.0％(9/50),65.8％(25/38)和3/4(x2＝22.934,P=0.000),A、B兩組比較差異有統計學意義(x2＝20.798,P=0.000)；胎兒閤併染色體異常的髮生率分彆為4.0％(2/50),7.9％(3/38)和0/4(x2 =0.878,P=0.645).4例重度側腦室擴張病例均終止妊娠,輕度側腦室擴張病例繼續妊娠的63例胎兒中(A和B組分彆為48例和15例),B組官內轉歸較A組差(B組側腦室擴張進展、穩定和縮小者分彆為3、10和2例,A組分彆為3、15和30例,Z=-3.317,P=0.001),A組中非孤立性側腦室擴張胎兒宮內預後較孤立性側腦室擴張者差(Z=-2.631,P=0.009).順利娩齣的62例新生兒在生後14d進行新生兒神經行為髮育情況評估,A、B兩組≥35分比例分彆為93.8％(45/48)和71.4％(10/14),差異有統計學意義(Fisher精確概率法,P=0.040).嬰兒齣生後12箇月(存活46例,A組35例,B組11例)採用貝利嬰幼兒髮展量錶(Bayley scales of infant development,BSID)評估,評分顯示A和B組運動髮育指數差異有統計學意義(A組髮育優秀、中等和低下者分彆為8、26和1例,B組分彆為1、7和3例,Z=-2.203,P＝0.043),但智力髮育指數評分2組間差異無統計學意義.存活嬰兒中20例行磁共振成像(magnetic resonance imaging,MRI)檢查,45.0％(9例)側腦室寬度縮小,50.0％(10例)側腦室擴張持續存在,5.0％(1例)側腦室擴張寬度增加.生後側腦室擴張轉歸情況與BSID評分相關,側腦室寬度縮小者較穩定和進展者預後好(P=0.033). 結論胎兒側腦室擴張寬度為10.0～12.0 mm者預後較好.超聲確診的側腦室擴張胎兒,建議進行相關病因學檢查,必要時行MRI檢查.對側腦室輕度擴張胎兒應加彊宮內及齣生後隨訪.
목적 탐토산전초성발현태인측뇌실확장적림상의의급예후. 방법 연구대상위2007년8월지2010년8월인초성발현측뇌실확장우남방의과대학남방의원부산과유전자순문진취진적92례단태임신잉부,근거태인측뇌실관도분위중도측뇌실확장(≥15.0 mm,4례)화경도측뇌실확장(10.0～14.9 mm,88례),경도측뇌실확장조우분위A조(10.0～12.0 mm,50례)화B조(12.1～14.9 mm,38례).대상관림상자료진행회고성분석,대궁내전귀、신생인출생후신경행위발육정황진행수방.통계방법채용x2검험(혹Fisher정학개솔법)、Bonfferoni방법교정、MannWhitney화Kruskal-Wallis검험. 결과 경도측뇌실확장적A화B조급중도측뇌실확장조태인합병기타계통발육이상(비고립성측뇌실확장)적발생솔분별위18.0％(9/50),65.8％(25/38)화3/4(x2＝22.934,P=0.000),A、B량조비교차이유통계학의의(x2＝20.798,P=0.000)；태인합병염색체이상적발생솔분별위4.0％(2/50),7.9％(3/38)화0/4(x2 =0.878,P=0.645).4례중도측뇌실확장병례균종지임신,경도측뇌실확장병례계속임신적63례태인중(A화B조분별위48례화15례),B조관내전귀교A조차(B조측뇌실확장진전、은정화축소자분별위3、10화2례,A조분별위3、15화30례,Z=-3.317,P=0.001),A조중비고립성측뇌실확장태인궁내예후교고립성측뇌실확장자차(Z=-2.631,P=0.009).순리면출적62례신생인재생후14d진행신생인신경행위발육정황평고,A、B량조≥35분비례분별위93.8％(45/48)화71.4％(10/14),차이유통계학의의(Fisher정학개솔법,P=0.040).영인출생후12개월(존활46례,A조35례,B조11례)채용패리영유인발전량표(Bayley scales of infant development,BSID)평고,평분현시A화B조운동발육지수차이유통계학의의(A조발육우수、중등화저하자분별위8、26화1례,B조분별위1、7화3례,Z=-2.203,P＝0.043),단지력발육지수평분2조간차이무통계학의의.존활영인중20례행자공진성상(magnetic resonance imaging,MRI)검사,45.0％(9례)측뇌실관도축소,50.0％(10례)측뇌실확장지속존재,5.0％(1례)측뇌실확장관도증가.생후측뇌실확장전귀정황여BSID평분상관,측뇌실관도축소자교은정화진전자예후호(P=0.033). 결론 태인측뇌실확장관도위10.0～12.0 mm자예후교호.초성학진적측뇌실확장태인,건의진행상관병인학검사,필요시행MRI검사.대측뇌실경도확장태인응가강궁내급출생후수방.
Objective To evaluate the clinical significance and prognosis of tetus with lateral ventriculomegaly.Methods We retrospectively analyzed 92 singleton pregnant women who were antenatally diagnosed with fetal ventriculomegaly by ultrasound in genetic conselling clinics,Department of Gynaecology and Obstetrics,Nanfang Hospital,Southern Medical University between August 2007 and August 2010.All participants were divided into three groups according to the width of the lateral ventricles:group A (10.0-12.0 mm,n＝50),group B (12.1-14.9 mm,n=38) and severe ventriculomegaly group (≥15.0 mm,n=4).All fetuses were followed up.Chi-square test(or Fisher's exact test),Bonfferoni method,Mann Whitney or Kruskal-Wallis test were used for statistics.Results In group A,B and severe ventriculomegaly group,18％ (9/50),65.8％(25/38)and 3/4 of fetuses were complicated with structural malformation,respectively (x2 =22.934,P =0.000),and statistical significance were found only between group A and B (x2 =20.798,P=0.000).The incidences of fetal chromosomal aberration were 4.0％ (2/50),7.9％ (3/38)and 0/4 in the three groups,respectively (x2＝0.878,P ＝ 0.645).Eventually,all four cases with severe cerebral ventriculomegaly were terminated.Among cases of mild ventriculomegaly,63 women continued the pregnancy (48 in group A and 15 in group B).The intrauterine improvement of group B was poorerthan that of group A (Z=-3.317,P =0.001).Respectively,three,ten and two cases of ventriculomegaly deteriorated,stabilized and regressed in group B,and the corresponding figures were 3,15 and 30 in group A.In group A,the prognosis of fetus with non-isolated ventriculomegaly was poorer than that of fetus with isolated ventriculomegaly (Z=-2.631,P=0.009).For neonates 14 days after birth (n=62),the rates of normal neonatal behavioral neurological assessment (NBNA) scoring were respectively 93.8％ (45/48) and 71.4％ (10/14) for groups A and B with statistical difference (Fisher's exact test,P =0.040).Bayley scales of infant development (BSID) used to evaluate infants at 12-month-old revealed that the psychomotor developmental index (PDI) between group A and group B had statistical difference (8,26 and 1 case of good,moderate and poor development in group A; one,seven and three cases in group B; Z=-2.203,P=0.043).However,the mental developmental index (MDI) between group A and B had no statistical difference.Twenty babies among the survived ones received magnetic resonance imaging (MRI) examination.The results showed that lateral ventricle width regressed in nine babies (45.0％) and progressed in one baby (5.0％).Ten cases (50.0％) did not change.The change of ventriculomegaly after birth was related to BSID evaluation.Better prognosis of fetuses were found in those with regressed ventriculomegaly (P=0.033).Conclusions Fetuses with mild ventriculomegaly (10.0 12.0 mm) have a favorable outcome.Further investigations,such as fetal development,chromosomal examination,intrauterine infection screening and MRI if necessary,are suggested for fetus with ventriculomegaly.Moreover,intensive intrauterine and postnatal follow-up is recommended.