北京市胎儿先天性脑积水的产前MRI诊断及围产期转归

Prenatal MRI diagnosis and perinatal outcome of fetal congenital hydrocephalus in Beijing

目的探讨北京市最近6年胎儿先天性脑积水(CH)的产前MRI诊断情况及围产期转归。方法选择2015年1月至2020年12月北京市出生缺陷监测系统内收集的被诊断为CH的468例胎儿及新生儿为研究对象,对CH诊断及围产期(宫内及出生0~6 d)死亡情况,进行回顾性分析。采用χ^(2)检验,对产前诊断与生后诊断的孤立性脑积水患儿围产期死亡率等,进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。结果①北京市出生缺陷监测系统最近6年的胎儿及生后7 d内新生儿CH发生率为3.57×10^(-4)(468/1310025)。本组468例CH患儿的产前诊断率为97.44%(456/468),产前检出的平均胎龄为24周,检出时胎龄≥28周者占26.53%(121/456)。②产前诊断的456例CH儿中,56例接受产前超声联合MRI检查者,占比为12.28%(56/456),其中40例CH患儿的MRI与超声诊断结果一致,其余16例的MRI检查结果对其颅内畸形具体类型进行补充诊断。③本组105例胎龄≥28周的孤立性脑积水患儿中,除外治疗性引产49例胎儿,其余56例患儿的围产期死亡率为14.29%(8/56)。产前诊断与生后诊断的孤立性脑积水患儿围产期死亡率分别为12.24%(6/49)、28.57%(2/7),二者比较,差异无统计学意义(χ^(2)=0.33,P=0.564);产前超声与产前超声联合MRI诊断的孤立性脑积水患儿围产期死亡率分别为11.63%(5/43)、16.67%(1/6),二者比较,差异无统计学意义(P=0.564)。结论MRI对产前超声诊断CH患儿的颅内畸形,具有补充诊断价值。

Objective To explore prenatal MRI diagnosis and perinatal outcome of fetal congenital hydrocephalus(CH)in Beijing in recent 6 years.Methods From January 2015 to December 2020,a total of 468 fetuses and newborns with CH included into Beijing Birth Defects Monitoring Network were selected as the study subjects.The diagnosis of CH and perinatal death data of intrauterine and within 0-6 d after birth were analyzed retrospectively.The perinatal mortality of children with isolated CH were compared between prenatal diagnosis and postnatal diagnosis by chi-square test.The procedure followed in this study was in line with World Medical Association Declaration of Helsinki revised in 2013.Results①The prevalence of CH fetuses and newborns within 0-6 d after birth from 2015 to 2020 in Beijing Birth Defects Monitoring Network was 3.57×10^(-4)(468/1310025).The prenatal diagnosis rate of 468 children with CH was 97.44%(456/468).The median gestational age when CH was detected in pregnancy was 24 weeks,and the gestational age≥28 weeks at the time of diagnosis of CH accounted for 26.53%(121/456).②Among 456 prenatal diagnosed cases,56 cases were examined by prenatal ultrasound combined with MRI,accounted for 12.28%(56/456).Among those 56 cases,results of MRI were consistent with ultrasound diagnosis in 40 cases,and 16 cases were supplementary diagnosed specific types of intracranial malformations.③Among 105 children with isolated hydrocephalus of gestational age≥28 weeks,except 49 cases were taken therapeutic induction labortion measures,the perinatal mortality rate of another 56 cases was 14.29%(8/56).The perinatal mortality rate of prenatal diagnosis and postpartum diagnosis of isolated hydrocephalus were 12.24%(6/49)and 28.57%(2/7),respectively,and there was no significant difference between them(χ^(2)=0.33,P=0.564).The perinatal mortality rate of prenatal ultrasound diagnosis and prenatal ultrasound combined MRI diagnosis of isolated hydrocephalus were 11.63%(5/43)and 16.67%(1/6),respectively,and there was no significant difference between them(P=0.564).Conclusion Prenatal MRI has supplementary diagnostic value for intracranial malformation than prenatal ultrasound in children with CH.