173例轻度和中度胎儿侧脑室扩张的妊娠结局和神经系统发育随访  

Pregnancy outcomes and neurodevelopment in 173 cases of mild or moderate fetal ventriculomegaly

作　　者：常清贤[1] 余艳红[1] 彭奕贤 黄丽萍[1] 肖超群[1] 陈翠华[2] 黎静[1] 宋兰林[1] 

机构地区：[1]南方医科大学南方医院妇产科,广州510515 [2]南方医科大学南方医院超声科,广州510515

出　　处：《中华围产医学杂志》2018年第1期11-17,共7页Chinese Journal of Perinatal Medicine

基　　金：广东省省级科技计划项目（2013802200018）;广州市科技计划（2014YZ-00115）

摘　　要：目的探讨不同程度、类型和宫内转归的胎儿侧脑室扩张的妊娠结局和神经系统发育情况。方法采用队列研究设计，分析2010年3月至2016年6月因产前超声提示＂胎儿侧脑室扩张＂到南方医科大学南方医院妇产科产前诊断中心就诊的173例单胎妊娠孕妇的临床资料。选取同期在本院产前检查的30例正常孕妇作为对照组。对继续妊娠者随访婴儿至生后6月龄，胎儿侧脑室宽度≥10 mm且≤12 mm为轻度侧脑室扩张（轻度组），〉12 mm且〈15 mm为中度侧脑室扩张（中度组）。当侧脑室扩张不伴其他颅内外异常、羊水量异常或超声软指标异常时为孤立性侧脑室扩张（isolated ventriculomegaly，IVM），否则为非孤立性侧脑室扩张（non-isolated ventriculomegaly，NIVM）。173例单胎妊娠孕妇中轻度组107例，其中IVM 54例，NIVM 53例；中度组66例，其中IVM 26例，NIVM 40例。所有研究对象均除外了染色体异常。采用新生儿行为神经测定（neonatal behavioral neurological assessment，NBNA）方法对生后7 d的新生儿进行神经发育情况评估，采用贝利婴幼儿发展量表的智力发育指数（mental development index，MDI）和心理运动发育指数（psychomotor development index，PDI）对6月龄婴幼儿进行神经系统发育情况评估。统计学方法采用t检验、χ2检验（或Fisher精确概率法）、非参数检验、Mann-Whitney检验、Kruskal-Wallis H检验。 结果（1）脑室扩张消退、稳定、进展：轻度组分别为78例（72.9%）、25例（23.4%）和4例（3.7%），中度组分别为30例（45.4%）、25例（37.9%）和11例（16.7%）（χ2=15.769，P〈0.001）；轻度组内IVM亚组和NIVM亚组之间比较，差异无统计学意义（χ2=2.412，P=0.299）；中度组内IVM亚组分别为17例（65.4%）、8例（30.8%）和1例（3.8%），NIVM组分别为13例（32.5%）、17例（42.5%）和10例（25.0%）（χ2=8.552，P=0.014）。（2）164例孕�ObjectiveTo investigate pregnancy outcomes and neurodevelopment in fetuses with ventriculomegaly.MethodsThis was a cohort study of 173 gravidas with singleton pregnancy who were diagnosed with fetal ventriculomegaly by ultrasound in Prenatal Diagnostic Center of Nanfang Hospital Affiliated to Southern Medical University from March 2010 to July 2016. Thirty normal gravidas who received antenatal care in the same hospital and at the same period were selected as control. Clinical data were collected. Gravidas who had chosen to continue their pregnancy were followed up to monitor the variations of fetal ventricular. Fetal mild and moderate ventriculomegaly were respectively defined as a ventricular atrial width of 10-12 mm and 〉12 mm but 〈15 mm. Isolated ventriculomegaly （IVM） indicated those without any other ultrasound abnormalities, otherwise the case would be defined as non-isolated ventriculomegaly （NIVM）. Among the 173 gravidas, 54 cases were mild IVM, 53 mild NIVM, 26 moderate IVM and 40 moderate NIVM. Fetuses with chromosome abnormalities were excluded from the study. Neonatal behavioral neurological assessment （NBNA） was used to analyze the neonatal neurodevelopment at the age of 7 days, and Bayley scales of infant development was used to evaluate the development of nervous system at the age of 6 months through analyzing their mental development index （MDI） and psychomotor development index （PDI）. Statistical methods included t test, χ2 test （or Fisher＇s exact test）, nonparametric test, Mann-Whitney test and multiple Kruskal-Wallis H test.Results（1） Among the 107 fetuses with mild ventriculomegaly, 72.9% （78）, 23.4% （25） and 3.7% （4） of them regressed, stabilized and progressed,respectively; however, among the 66 moderate cases, the figures were 45.4% （30）, 37.9% （25） and 16.7% （11） respectively （χ2=15.769, P〈0.001）. For those in the IVM and NIVM subgroups within the moderate ventriculomegaly group, significant difference was shown [17（65.4%

关 键 词：侧脑室扩张 妊娠结局 中枢神经系统 超声检查 产前 随访研究 

分 类 号：R714.5[医药卫生—妇产科学]