241例胎儿侧脑室增宽的结局随访

Clinical outcomes of 241 cases with fetal ventriculomegaly

目的探讨不同程度胎儿侧脑室增宽的妊娠结局和预后。方法研究对象为复旦大学附属妇产科医院2004年1月至2013年12月共241例因B超诊断为胎儿侧脑室增宽行多科会诊的病例。根据胎儿侧脑室宽度，将这些病例分为轻度组（≥10～〈12mm，151例）、中度组（≥12～〈15mm，56例）和重度组（≥15mm，34例）。记录B超随访、新生儿检查结果及出生后的随访资料。采用z。检验或Fisher精确概率法进行统计学分析，率的多重比较采用Bonferroni方法校正。结果241例孕妇中，91例（37．8％）终止妊娠，其余150例（62．2％）继续妊娠至分娩。这150例孕妇中，孕期胎儿侧脑室宽度缩小者42例（28．0％），侧脑室宽度无明显变化者108例（72．O％）；轻度组105例，中度组30例，重度组15例。42例侧脑室宽度缩小者中，轻度组31例患儿侧脑室宽度恢复正常，其中l例生后出现有耳听力异常；中度组10例患儿中，9例侧脑室宽度恢复正常，1例缩小为轻度侧脑室增宽，这10例生后均未见明显异常；重度组1例的左、右侧脑室宽度分别由16．0和18．0mm缩小至14．0和16．0mm，生后未见明显异常。对108例侧脑室宽度无明显变化者随访发现，轻、中、重度组出现异常结局的比例分别为14．9％（11／74）、10．0％（2／20）和6／14。孕期胎儿侧室宽度缩小者的预后明显优于侧脑室宽度无明显变化者f2．4％（1／42）与17．6％（19／108），x^2=4．940，P=0．026]。150例继续妊娠者中，轻、中、重度组出现异常结局的比例分别为11．4％（12／105）、6．7％（2／30）和6／15，差异有统计学意义（矿=6．908，P=0．032）。其中，中度和轻度组分别与重度组相比，出现异常结局的比例差异均有统计学意义（x^2=4．929，P=0．026；x^2=5．266，P=0．022）。241例孕妇中，因高龄、胎儿侧脑室增宽或唐氏综合征筛查高危等原因行染色体检查者共57例，5例（8．8％）发现异常。轻、中和重度组染色体异常的比例分别为7．0％（3／43）、1／8和1／6。29例孕妇检查发现1例风疹病毒IgM阳性，2例巨细胞病毒IgM阳性，1例弓形虫IgM阳性。结论胎儿侧脑室增宽程度及宫内转归与妊娠结局和预后相关。

Objective To evaluate the pregnancy outcomes and prognosis of fetuses with different levels of ventrieulomegaly. Methods Fetuses with ventriculomegaly subjected to the multidisciplinary consultation in the Obstetrics and Gynecology Hospital of Fudan University between January 2004 and December 2013 were included in this study. The fetuses were divided into three groups according to the width of the lateral ventricles on ultrasound examination as follows： mild ventriculomegaly （Mild Group, ≥ 10 - 〈12 mm, 151 cases）, moderate ventrieulomegaly （Moderate Group, ≥ 12 - 〈15 mm, 56 cases） and severe ventriculomegaly （Severe Group, ≥15 mm, 34 cases）. All cases were followed up with additional ultrasound scans during pregnancy and follow-up was continued until the children were almost nine years old. Chi-square test, Fisher＇s exact test and Bonferroni method were used to analyze the data. Results Two hundred and forty one fetuses were followed up. Ninety-one cases were terminated, and 150 were born （105 cases in Mild Group, 30 cases in Moderate Group, and 15 cases in Severe Group）. During ultrasound follow-up of the 150 cases, the lateral ventricle width regressed in 42 cases （28.0%） and remained stable in 108 cases （72.0%）. In the regressed group, the ventricle width in 31 cases in the Mild Group regressed to normal and a hearing abnormality was noted in one case after birth. In the Moderate Group, the lateral ventricle width in nine cases regressed to normal, one case had mild ventriculomegaly, and none of these cases showed abnormalities after birth. One case in the Severe Group showed no abnormalities, while the width of the lateral ventricles decreased to 14.0 and 16.0 mm. With regard to the outcomes of lateral ventricle width with or without regression, one of 42 cases in the regressed group had a significant abnormality, while 19 of 108 cases in the stable group [eleven cases （14.9%, 11/74） in Mild Group, two （10.9%, 2/20） in Moderate Group, and six （6/14） in Severe Group] showed significant abnormalities. Statistically significant differences were found between the two groups [2.4%（1/42） vs 17.6%（19/108）, x^2=4.940, P=0.026]. When the outcomes of the three groups were compared, 12 of 105 cases in the Mild Group （11.4%）, two of 30 cases in the Moderate Group （6.7%）, and 6 of 15 cases in the Severe Group （6/15） had significant abnormalities. Statistically significant differences were found between the three groups （x^2=6.908, P=0.032）. Statistical significance was observed in the Moderate Group and Severe Group （x^2=4.929, P=0.026）, while the Mild Group had a more favorable prognosis than the Severe Group 0（2-5.266, P=0.022）. Chromosomal examinations were carried out in 57 cases and the incidence of chromosomal abnormalities was 8.8%（5/57） [7.0% （3/43）, 1/8 and 1/6 in the three groups, respectively]. Infection screening was performed in 29 cases and one case was found to be positive for rubella virus lgM, two cases were positive for cytomegalovirus-IgM, and one case was positive for toxoplasma gondii-IgM. Conclusions Pregnancy outcomes and the prognosis of fetal ventriculomegaly are associated with the degree and progression of ventricular dilatation.