胎儿单纯性室间隔缺损预后的前瞻性研究  

Prospective study on the isolated ventricular septal defect in fetus

作　　者：余莉[1] 谢亮[6] 朱琦[2] 代礼[5] 华益民[1] 刘丽筠 陈娇[2] 郭楠[2] 熊菲[4] 毛萌 熊英[3] 刘瀚旻[1] 

机构地区：[1]四川大学华西第二医院儿童心血管科,成都610044 [2]四川大学华西第二医院超声科,成都610044 [3]四川大学华西第二医院新生儿科,成都610044 [4]四川大学华西第二医院儿童保健科,成都610044 [5]四川大学华西第二医院出生缺陷检测中心,成都610044 [6]四川大学西部妇女儿童研究院肺血管重构研究室 [7]成都市妇女儿童中心医院

出　　处：《中华儿科杂志》2015年第1期30-33,共4页Chinese Journal of Pediatrics

基　　金：基金项目：国家重点基础研究发展计划（2007CB511905）;四川省科技厅科技支撑计划（2014SZ0049）

摘　　要：目的探讨胎儿室间隔缺损（VSD）的自然病程，分析其自然闭合率与缺损直径大小及类型的关系。方法2011年6月至2014年6月，以四川大学华西第二医院为现场，招募建卡的孕妇，纳入孕中、晚期经胎儿心脏超声检查确诊为胎儿单纯性VSD者234例，进行前瞻性随访研究，以VSD自然闭合或接受手术治疗为观察终点，分析胎儿VSD直径大小、类型与其自然闭合率的关系。不同组别间自然闭合率比较采用）（2检验。结果胎儿心脏超声诊断VSD234例，至随访终点，5例仍在妊娠中，12例失访，故纳入本研究对象217例。其中分娩189例（87．1％），终止妊娠28例（12．9％）。189例娩出的患儿中，10例于6个月内死亡，故纳入VSD自然闭合率分析179例，自然闭合81例，总体自然闭合率为45．2％。出生前宫内自然闭合49例，闭合率为27．4％（49／179）；出生后自然闭合32例，闭合率为17．9％（32／179），生后12个月内闭合者24例，自然闭合率为13．4％（24／179），占出生后自然闭合者的75％（24／32）。按照胎儿VSD直径大小分为三组，≤2．0mm组87例，自然闭合51例，闭合率为59％（51／87），2．1-5．0mm组84例，自然闭合30例，闭合率为36％（30／84），〉5．0mm组8例，无自然闭合。不同组别自然闭合率进行比较，差异有统计学意义（x^2=15．200，P=0．001）。按照胎儿VSD类型分为膜周型组和肌部组，其中膜周型组152例，自然闭合69例，闭合率为45．4％，肌部组27例，自然闭合12例，闭合率为44％（12／27），两组室间隔缺损自然闭合率比较，差异无统计学意义（x^2=0．008，P=0．950）。结论胎儿室间隔缺损在宫内孕晚期有较高的自然闭合率。出生后室间隔缺损闭合时间大多在1岁以内。缺损直径小者自然闭合率高。Objective Congenital heart defect is one of the most common birth defects. The isolated ventricular septal defect （VSD） has higher morbidity, and spontaneous closure may occur. Previously many studies about the prognosis of ventricular septal defect in childhood were conducted; in contrast, few studies on evolution and prognosis of ventricular septal defect from fetus to postnatal life have been available. This research aimed to determine the evolution of isolated ventricular septal defect during the period of fetus and postnatal life, and analyze the association between the diameter or location of VSD and the spontaneous closure of VSD. Method All pregnant women seen at the prenatal diagnosis center of the West China Second Hospital were recruited. From June 2011 to June 2014, these participants underwent the fetal 2-dimensional and color Doppler echocardiographic examinations, and the fetuses with isolated VSD were included in the study, and those with other malformations or abnormal chromosome were excluded. Thisstudy was a prospective and longitudinal research. These fetuses were followed-up until the VSD closed spontaneously, or were surgically repaired or percutaneously closed. Outcomes of all the cases were recorded. Result There were 234 fetuses with isolated VSD who were recruited in our research cohort. Twelve of 234 lost to follow-up, 5 of 234 were still in uterus. Totally 217 fetuses were followed up. One hundred eighty-nine of 217 （87. 1% ） cases were delivered. The pregnancies were terminated in 28 of 217 （12. 9% ） cases. Ten cases died after birth. Of the 179 delivered cases, the rate of VSD spontaneous closure was 45.2% （81/179） , the VSD of 49 cases （27.4% ,49/179） spontaneously closed in uterus. The VSD of 17.9% （32/179） cases spontaneously closed after birth and those of 75% （24/32） cases closed in the first year of life. Furthermore, these participants were divided into 3 groups according to the diameter of VSD in fetus. There were 87 cases in≤2. 0 mm group, 51 sp

关 键 词：室间隔缺损 胎儿 预后 前瞻性研究 

分 类 号：R714.5[医药卫生—妇产科学]