CAJ | 학술논문

目的：应用三维超声对比评价先天性心脏病胎儿和正常胎儿小脑容积发育的差异。方法采集孕20~36+6周龄168例正常胎儿和73例先天性心脏病胎儿的小脑三维图像,采用虚拟器官计算机辅助分析技术(VOCAL)30°旋转法勾勒计算小脑容积,比较两组之间差异,在各孕周应用秩和检验探讨容积差异出现的最初孕龄,应用多元回归分析先天性心脏病各亚型对胎儿小脑发育的影响。结果两组胎儿的小脑容积均随孕周增加而增长,但从孕28周开始,先天性心脏病胎儿小脑容积进行性小于正常组(P <0.01)。先心病类型与小脑容积发育迟缓有明显相关性(R2=0.852,P <0.001),左心发育不良综合征胎儿小脑发育迟缓最明显,随后是主动脉发育不良、完全性大动脉转位和法洛四联症。结论先天性心脏病胎儿存在一定程度的小脑发育迟缓,特别是左心发育不良综合征、主动脉发育不良和完全性大动脉转位胎儿。产前监测先天性心脏病胎儿小脑发育有利于产前咨询和产后及早神经保护干预。
목적：응용삼유초성대비평개선천성심장병태인화정상태인소뇌용적발육적차이。방법채집잉20~36+6주령168례정상태인화73례선천성심장병태인적소뇌삼유도상,채용허의기관계산궤보조분석기술(VOCAL)30°선전법구륵계산소뇌용적,비교량조지간차이,재각잉주응용질화검험탐토용적차이출현적최초잉령,응용다원회귀분석선천성심장병각아형대태인소뇌발육적영향。결과량조태인적소뇌용적균수잉주증가이증장,단종잉28주개시,선천성심장병태인소뇌용적진행성소우정상조(P <0.01)。선심병류형여소뇌용적발육지완유명현상관성(R2=0.852,P <0.001),좌심발육불량종합정태인소뇌발육지완최명현,수후시주동맥발육불량、완전성대동맥전위화법락사련증。결론선천성심장병태인존재일정정도적소뇌발육지완,특별시좌심발육불량종합정、주동맥발육불량화완전성대동맥전위태인。산전감측선천성심장병태인소뇌발육유리우산전자순화산후급조신경보호간예。
Objective To assess the cerebellum volume growth in fetuses with congenital heart disease (CHD).Methods The cerebellum volume (CV)were compared prospectively in 168 normal fetuses and 73 fetuses with CHD using 3D ultrasound combined with VOCAL software at 20-36+6 weeks of gestation.The differences in fetal brain volumes at each gestational week were analyzed using a Wilcoxon rank sum test to determine the timing of volumetric reduction.Multiple regression analyses were performed to identify risk factors for volume reduction in the groups.Results From the 28th week of gestation onwards,cerebellum volumes were progressively smaller in CHD fetuses relative to controls (P <0.01 ). The multivariable analysis showed that the diagnostic category (R2=0.852,P <0.001)was independently associated with smaller cerebellum volumes in fetuses with CHD.The highest ratios occurred in hypoplastic left heart syndrome (HLHS),followed by aorta hypoplasia,transposition of the great arteries (TGA)and tetralogy of Fallot (TOF).Conclusions The cerebellum volume growth is impaired in fetuses with complex CHD,particularly in those with HLHS,aorta hypoplasia or TGA.This study highlights a need for routine brain screening and early intervention to improve neurodevelopmental outcomes in fetuses with complex CHD.