新生儿室管膜下囊肿预后的前瞻性观察

Prospective study on prognosis of infants with neonatal subependymal cysts

目的 观察新生儿室管膜下囊肿 (SEC)的近期和远期预后。方法 对 70例经头颅B超诊断为室管膜下囊肿的新生儿和 70例无囊肿新生儿应用PCR方法分别进行血、尿巨细胞病毒(CMV)、血弓形虫 (TOXO)的检测。同时应用ELISA方法对两组新生儿进行血CMV、弓形虫、风疹病毒抗体的检测。分别在 3、6、12个月以及 6岁时进行跟踪随访 ,检查内容包括头颅B超检查、体格测试、智能测试、脑干听觉诱发电位检查以及眼科检查。结果 在生后 6年内 ,囊肿组患儿智能发育指数小于 80的发生率始终显著高于对照组 ;其身高、体重在生后 12个月内显著低于对照组 ,至 6周岁时则接近对照组 ;两组的脑干听觉诱发电位及眼科检查均未见异常。结论 囊肿新生儿的体格发育在生后 1年内可呈暂时落后 ,智能发育落后可持续至学龄前期。提示对新生儿进行常规头颅B超检查很有必要 。

Objectives It is confirmed that most neonatal subependymal cysts (SEC) are closely correlated with intrauterine infection and the short-term prognosis of SEC is not very good. Little information about the long-term prognosis of SEC is available. The purpose of the present study was to explore the short-term and long-term prognosis of neonatal SEC cases via a 6-year follow up. Methods Seventy SEC neonates detected by cranial ultrasound between October 1993 and October 1994 were enrolled into SEC group and 70 healthy neonates into control group. Serum antibodies (IgG and IgM) to cytomegalovirus (CMV) , toxoplasma and rubella virus and PCR for these pathogens (except for rubella virus) were measured in the two groups. CMV-PCR was also performed for urine specimens. Cranial sonography assessment, physical growth evaluation, Bayley developmental scale or Wyeth developmental scale, brain-stem auditory evoked potential (BAEP) and vision examination were undertaken at 3、6、12 months and 6 years in the two groups. Results The positive rate of CMV-IgM and blood CMV-PCR in SEC group was significantly higher than those of control group (19.1% vs. 5.7%, 12.9% vs. 2.9%). The positive rate of urine CMV-PCR in SEC group was also significantly higher (40% vs 17.1%). No significant difference could be found in the positive rate of PCR for toxoplasma and rubella-IgM between the two groups. The weight and height of infants with SEC were obviously lower than those in control group during the first year after birth. The parameters of the physical development in SEC infants reached the similar level as controls till 6 years old. However, the index of mental development below 80 was more often seen in infants with SEC comparing to that in control group during the whole six years. There were no abnormal findings either in BAEP or vision examination in the two groups. Conclusion Infants with SEC may show a transient retardation of physical growth after birth, while their mental developmental retardation might last for longer time. It is suggested that cranial ultrasound examination should be performed in all neonates for the detection of SEC, and a longer follow-up should be done for infants with SEC.