圆锥动脉干畸形胎儿大脑沟回发育的产前超声初步研究

The prenatal ultrasonic study of cerebral sulci and gyrus development in fetuses with conotruncal defects at the second and third trimester

目的观察中晚孕期圆锥动脉干畸形（CTD）胎儿大脑沟回发育的超声表现，提高临床工作者对CTD胎儿大脑皮质发育的认识。方法选择2015年12月至2017年1月于南方医科大学附属深圳市妇幼保健院行产前检查的孕妇180例，所有孕妇均为单胎妊娠。其中CTD组胎儿60例，孕龄为20～33^＋6周，均经胎儿超声心动图诊断。CTD包括永存动脉干畸形、法洛四联症、大动脉转位和右室双出口。评估大脑沟回指标包括顶枕沟深度及角度、外侧裂宽度及深度、脑岛未覆盖宽度、脑岛未覆盖率、距状沟深度和头围；评估血流动力学指标包括脐动脉阻力指数、脐动脉搏动指数、大脑中动脉阻力指数、大脑中动脉搏动指数、脑胎盘血流阻力指数比和脑胎盘血流搏动指数比；并对上述参数进行统计分析。结果在本研究的孕周中CTD组胎儿的顶枕沟深度和外侧裂宽度较对照组小，脑岛未覆盖率较对照组大（均P〈0．05）；CTD组胎儿大脑中动脉阻力指数、大脑中动脉搏动指数和脑胎盘血流搏动指数较对照组小（均P〈0．05）。结论圆锥动脉干畸形胎儿血流动力学改变可能是该类心脏畸形胎儿大脑沟回发育延迟的一个原因。

Objective To evaluate the development of cerebral sulcl and gyrus in fetuses with conotruncal defect （CTD） at the second and third trimester by ultrasound, and to improve clinician＇s understanding of the cerebral cortical development in fetuses with CTD. Methods The study was conducted at Shenzhen Maternity and Child Healtheare Hospital Affiliated to Southern Medicial University from December 2015 to January 2017, enrolled 180 women with single fetus, among whom 60 fetuses with CTD and gestational age between 20 weeks to 33^＋6 weeks were diagnosed by echocardiographic examination. CTD included persistent truncus arteriosous, tetralogy of fallot, transpofition of the great arteries and double outlet of right ventricle. Evaluation indexes of cerebral sulci and gyrus included depth and angle of partetooccipital sulcus, width and depth of sylvian fissure, uncovered width of insular, uncovered insular ratio, depth of calcarine sulcus, head circumference ; evaluation indexes of hemodynamics included umbilical artery resistance index, umbilical artery pulsation index, middle cerebral artery resistance index, middle cerebral artery pulsation index, the cerebral-to-placental resistance ratio and the cerebroplacental pulsation ratio. Above indexes were measured for statistical analysis. Results At the whole gestational age in the study, depth of parietooccipital sulcus and width of sylvian fissure in CTD fetuses were smaller than those in the control group, uncovered insular ratio was larger than that in the normal group （ P 〈0. 05） ; middle cerebral artery resistance index, middle cerebral artery pulsation index and the cerebroplacental pulsation ratio in CTD fetuses were lower than those of the control group （ P 〈0.05）. Conclusions The change of hemodynamics in fetuses with CTD may be one of the reasons that fetuses with CTD have cerebral cortical hypoevolutism.