产前MRI预测先天性膈疝胎儿出生并接受治疗后转归

Prenatal MRI for predicting outcomes of congenital diaphragmatic hernia fetuses after birth and treatments

目的观察产前MRI预测先天性膈疝(CDH)胎儿出生并接受治疗后转归的价值。方法回顾性分析55胎经产前超声及MRI诊断CDH胎儿(CDH组)及同期55胎孕周与CDH组匹配、经产前超声排除膈疝及其他消化系统畸形胎儿(非CDH组),记录妊娠结局及出生后治疗情况,根据出生并接受治疗后是否存活将CDH组分为存活亚组及死亡亚组;比较组间预估肺体积比(PPLV)和理想肺体积比,以及CDH组内亚组间胎儿一般资料和产前MRI所见的差异。采用二元logistic回归分析影响CDH胎儿出生并接受治疗后转归的因素;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估PPLV预测CDH胎儿出生并接受治疗后转归的效能。结果组间不同孕周胎儿PPLV差异有统计学意义(P均<0.05),而理想肺体积比差异无统计学意义(P均>0.05)。CDH组出生后41例接受治疗后存活、14例死亡,亚组间分娩时孕周、出生后住院时间及产前MRI是否显示疝囊、肝脏疝入与否、双肺体积及PPLV差异均有统计学意义(P均<0.05)。分娩时孕周和PPLV均为CDH胎儿出生并接受治疗后转归的独立影响因素(P均<0.05);以PPLV预测CDH胎儿出生并接受治疗后转归的AUC为0.964。结论产前MRI可有效预测CDH胎儿出生并接受治疗后转归。

Objective To investigate the value of prenatal MRI for predicting the outcomes of congenital diaphragmatic hernia(CDH)fetuses after birth and treatments.Methods Data of 55 fetuses with prenatal ultrasound and MRI(CDH group)diagnosed CDH and 55 fetuses with matched gestational weeks but without diaphragmatic hernia nor other digestive system abnormalities(non-CDH group)were retrospectively analyzed.The treatments and outcomes were recorded,and fetuses in CDH group were divided into survival subgroup and death subgroup according to survival or not.The percent predicted lung volume(PPLV)and ideal lung volume ratio were compared between groups,while the clinical data and prenatal MRI findings were compared between subgroups within CDH group.Binary logistic regression analysis was performed to explore the impact factors of the outcomes of CDH fetuses after birth and treatments.Receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of PPLV for predicting the post-natal treatment outcome of CDH fetuses.Results Significant difference of fetal PPLV were found between group at different gestational weeks(all P<0.05),but not of ideal lung volume ratio(all P>0.05).After birth and treatments,among 55 fetuses in CDH group,41 survived(survival subgroup)but 14 died(death subgroup).There were significant differences of gestational weeks at delivery,the length of hospital stay after birth and prenatal MRI findings of presence of hernia sac or not,of liver herniation or not,as well as the volume of both lungs and PPLV between subgroups(all P<0.05).Gestational weeks at delivery and PPLV were both independent impact factors of the post-natal treatment outcome of CDH fetuses(both P<0.05).AUC of PPLV for predicting the post-natal treatment outcome of CDH fetuses was 0.964.Conclusion Prenatal MRI could be used to effectively predict the outcomes of CDH fetuses after birth and treatments.