胎儿侧脑室增宽与预后的荟萃分析

Meta analysis of fetal lateral ventriculomegaly and prognosis

目的对国内、外侧脑室增宽（VM）胎儿的神经系统预后相关的文献进行系统综述，探讨VM胎儿出生1年后的神经系统发育情况。方法检索万方数据库、中国知网、中国生物医学文献数据库、PubMed数据库、EMBASE数据库及Cochrane图书馆，收集1980年1月1日至2017年11月22日发表的相关文献。依据纳入与排除标准提取文献，以Newcastle．OttawaScale评价表对文献进行质量评价，采用R软件进行荟萃分析，对纳入的研究进行异质性检验后，选择相应的效应模型合并分析VM胎儿与其神经系统预后的情况。结果共纳入文献5篇，均为高质量的文献（评分均〉5分）。纳入的VM胎儿共718例。（1）轻度VM胎儿神经系统预后的良好率为88％（95％CI为0．77．0．95），中度VM胎儿为57％（95％CI为0．18～0，91），重度VM胎儿为36％（95％CI为0．16．0．59）。（2）孤立性VM胎儿神经系统预后的良好率为86％（95％CI为0．75～0．94），非孤立性VM胎儿为58％（95％CI为0．20～0．91）。（3）VM胎儿染色体异常的发生率为7％（95％CI为0．05～0．09）。（4）妊娠期胎儿侧脑室宽度缩小者的比例为41％（95％CI为0．27-0．57）。结论轻度VM胎儿的神经系统预后较中度及重度者更好；孤立性VM胎儿的神经系统预后较非孤立性者更好。胎儿VM可能与其染色体异常及宫内感染有关。妊娠期应定期监测胎儿侧脑室宽度的变化，告知不良预后的风险，同时建议请儿科医师评估。

Objective To explore the neurological development of fetal with ventriculomegaly at 1 year after birth by systematically reviewing the domestic and international literature about prognosis of fetal ventriculomegaly. Methods Wanfang database, CNKI, CBM, PubMed, EMBASE and the Cochrane Library were online searched to collect relevant literature published from January 1st, 1980 to November 22th, 2017. Literature were extracted based on the Newcastle-Ottawa Scale （NOS）, and analyzed by R software for meta- analysis. The corresponding model was selected according to the results of heterogeneity test to comprehensively analyze the prognosis of the fetus with ventrieulomegaly. Results Five studies were included in the meta analysis, all of them were of high quality （scores〉5）. （1）The good prognosis rate of nervous system was 88% （95%CI：0.77-0.95） in fetus with mild ventriculomegaly, was 57% （95%CI：0.18- 0.91） in those with moderate ventriculomegaly, and was 36% （95%CI：0.16-0.59） in those with severe ventriculomegaly. （2）The good prognosis rate of the nervous system was 86% （95%CI：0.75-0.94） in fetus with the isolated ventriculomegaly, while was 58% （95%CI： 0.20-0.91） in those with non-isolated ventriculomegaly. The incidence of chromosomal abnormalities was 7% （95%CI：0.05-0.09） in ventriculomegaly. The improvement rate of lateral ventricle width in pregnancy was 41% （95%CI：0.27-0.57）. Conclusions The prognosis of nervous system with mild ventrieulomegaly is better than that of moderate and severe ventriculomegaly. The prognosis of nervous system with isolated ventriculomegaly is better than that of non- isolated ventrieulomegaly. Fetal ventriculomegaly may be associated with fetal chromosomal abnormalities and intrauterine infection. The variation of fetal lateral ventricular width should be monitored regularly during pregnancy, the risk of poor prognosis should be informed, and pediatrician should be asked for evaluation.