孤立性侧脑室增宽胎儿的产前诊断及妊娠结局

Prenatal Diagnosis and Pregnancy Outcome of Isolated Ventriculomegaly Fetus

目的探讨产前影像学诊断胎儿孤立性侧脑室增宽(IVM)的宫内转归及妊娠结局。方法回顾性分析2012年1月—2017年12月确诊并获得完整产检资料和妊娠结局的IVM胎儿216例。依据首次超声诊断胎儿侧脑室宽度进行分组:轻度组,10 mm≤侧脑室宽度<12 mm;中度组,12 mm≤侧脑室宽度<15 mm;重度组,侧脑室宽度≥15 mm。采用Kruskal-Wallis检验、logistic回归分析IVM宫内转归的影响因素。结果(1)IVM胎儿染色体异常检出率为13.5%(7/52),先天性巨细胞病毒感染检出率为5.8%(3/52);(2)首次诊断的侧脑室宽度与宫内转归相关(χ^(2)=8.825,P=0.012);与好转比较,稳定及进展均为影响胎儿预后的危险因素(OR=19.196,387.141);(3)侧脑室宽度影响胎儿预后,首次超声诊断侧脑室宽度与预后相关(中重度组vs轻度组,OR=7.220);产前末次复查的侧脑室宽度对胎儿预后的预测价值更高,产前侧脑室宽度恢复正常者预后均良好(中度组vs轻度组,OR=5.060;重度组vs轻度组,OR=65.167);侧脑室宽度影响患儿神经系统后遗症康复效果(χ^(2)=16.309,P<0.001);(4)双侧脑室增宽增加不良预后风险(OR=3.667)。结论IVM胎儿应进行介入性产前诊断遗传学检查及病原学检查;侧脑室宽度、宫内转归及增宽脑室侧数都是影响胎儿预后的高危因素,即使是轻、中度侧脑室增宽胎儿仍有出现神经系统后遗症风险,应当注意孕期及出生后的定期检查。

Objective To explore the intrauterine and pregnancy outcomes of isolated ventriculomegaly(IVM)fetus.Methods Data of antenatal care and pregnancy outcomes were analyzed retrospectively in 216 fetuses with IVM,whom were diagnosed at Fujian Provincial Maternity and Children's Hospital from January 2012 to December 2017.Cases were divided into three groups according to ventricular width in the first ultrasound diagnosis:mild group(ventriculomegaly,≥10.0 mm and<12 mm),moderate group(ventriculomegaly,≥12.0 mm and<15 mm),and severe group(ventriculomegaly,≥15 mm).The comparison of intergroup rate was performed with Kruskal-Wallis and logistic regression analysis.Results(1)Interventional prenatal diagnosis were carried out in 52 cases,the incidence of chromosomal abnormalities was 13.5%(7/52),Congenital cytomegalovirus infection was 5.8%(3/52);(2)The width of lateral ventricle at the first scanning affects the intrauterine progression(χ^(2)=8.825,P=0.012),and stability and progression were the risk factors for fetal prognosis(OR=19.196,387.141,respectively);(3)The widths of lateral ventricle was risk factors for outcome of IVM fetus;the width at the first ultrasonic diagnosis,moderate and severe vs mild group OR was 7.22;the width at the last prenatal examination had a higher predictive value for fetal outcomes,all the cases that recovered to normal prenatal had good prognosis,while moderate vs mild group OR was 5.060;and severe vs mild group OR was 65.167;the width affected the effect of fetal rehabilitation of neurological sequelae(χ^(2)=16.309,P<0.001);(4)Bilateral ventriculomegaly increased risk of poor prognosis(OR=3.667).Conclusions Interventional prenatal diagnosis should be provided to IVM fetus.Lateral ventricular width,intrauterine progression,bilateral ventriculomegaly are all risk factors for fetal prognosis.Even mild or moderate ventriculomegaly is at risk of neurological sequelae,therefore we should pay more attention to such cases during pregnancy and after birth.