孤立性侧脑室扩张胎儿的结局及其影像学随访的结果  

Analysis of the prognosis of isolated ventriculomegaly and outcome of imaging follow-up

作　　者：彭奕贤 黄莉萍[1] 黎静[1] 余艳红[1] 陈翠华[1] 陈思瑾[1] 常清贤[1] Peng Yixian;Huang Liping;Li Jing;Yu Yanhong;Chen Cuihua;Chen Sijin;Chang Qingxian(Department of Obestetrics and Gynecology, Nanfang Hospital Affiliated to Southern Medicial University, Guangzhou 510515, China)

机构地区：[1]南方医科大学南方医院妇产科,广州510515

出　　处：《中华妇产科杂志》2018年第5期294-298,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：广东省科技计划（20138022000018）;广州市科技计划（2014Y2-00115）

摘　　要：目的探讨轻、中度孤立性侧脑室扩张（IVM）胎儿出生后的临床结局及分析其出生前、后的影像学检查的结果。方法收集2013年6月至2016年12月于南方医科大学附属南方医院就诊、产前超声诊断为IVM（即侧脑室扩张但不伴有其他结构异常）胎儿的单胎孕妇161例，其中胎儿轻度IVM者116例（72.0%），中度IVM者45例（28.0%），分析其产前超声检查、妊娠结局等临床资料，并对其在出生后进行新生儿行为神经系统测定（NBNA）量表、Bayley婴幼儿发展量表（BSID）评分，结合患儿出生后MRI检查的结果，综合评估患儿神经系统发育的情况。结果（1）分娩前超声检查：80.1%（129/161）的IVM胎儿在分娩前侧脑室扩张消失，26例（16.1%，26/161）胎儿的侧脑室宽度维持稳定，6例（3.7%，6/161）胎儿的侧脑室宽度扩张持续进展。（2）出生后MRI检查：83例（51.6%，83/161）新生儿行头颅MRI检查。8例（9.6%，8/83）新生儿的侧脑室扩张，其中3例（3.6%，3/83）检查出在胎儿期未被超声检查发现的结构异常（包括1例为胼胝体发育不良，2例为脑白质发育异常），新发现其他结构异常的检出率为3/8。（3）出生后神经系统发育量表评估：79例（49.1%，79/161）IVM胎儿出生后进行了神经系统发育量表评分，其中7例（8.9%，7/79）NBNA量表、6例（7.6%，6/79）BSID-心理运动发育指数（PDI）及3例（3.8%，3/79）BSID-智力发育指数（MDI）的评分低下；轻、中度IVM者的NBNA及BSID评分分别比较，差异均无统计学意义（NBNA：χ2=2.042，P=0.210；BSID-PDI：χ2=-1.359，P=0.174；BSID-MDI：χ2=-1.205，P=0.228）。随访9例（11.4%，9/79）BSID评分低下者，发现其中6例为宫内侧脑室扩张稳定，且出生后行超声和MRI检查其侧脑室宽度正常。结论大部分IVM胎儿的预后良好，但也存在神经系统发育不良的风险，其出生后应行MRI复查，应注重影�ObjectiveTo evaluate the clinical outcome of fetus diagnosed as mild and moderate isolated ventriculomegaly （IVM） and its correlation with imaging follow-up.MethodsTotally, 161 cases of single pregnancy whose fetus was diagnosed as mild or moderate IVM by ultrasound were administrated. Data of prenatal ultrasound examination, pregnancy outcomes, and the postnatal MRI results were collected. New borns′ growth and development, language expression, movement coordination, auditory and visual function were followed up to evaluate the neurodevelopment.Results（1） Before birth： 80.1% （129/161） of IVM disappeared before the delivery, 16.1% （26/161） remained stable, and 3.7% （6/161） continued to deteriorate. （2） Postnatal MRI： 8 cases （9.6%, 8/83） were diagnosed IVM, of which 3 cases were found additional abnormalities （1 case was the corpus callosum dysplasia and 2 cases were leukodystrophy） . The additional abnormal detection rate was 3/8. （3） Postnatal assessments： There were 7 cases （8.9%, 7/79） neunatal behavioral neurological assessment （NBNA） , 6 cases （7.6%, 6/79） Bayley scales of infant development （BSID） -psychomotor developmental index （PDI） and 3 cases （3.8%, 3/79） BSID-mental development index （MDI） whose scores were low. There was no significant difference of the NBNA and BSID scores between mild and moderate IVM （NBNA： χ2=2.042, P=0.210; BSID-PDI： χ2=-1.359, P=0.174; BSID-MDI： χ2=-1.205, P=0.228） . Follow-up of 9 cases （11.4%, 9/79） with low BSID score, 6 of them were found to be stable in the medial ventricle of the uterus, and the size of the lateral ventricle was normal after birth by ultrasound and MRI.ConclusionsThe majority of IVM fetuses have good prognosis, but there is also a risk of neurodevelopmental dysplasia. The postnatal follow-up should be paid attention to, and MRI should be performed as the postnatal imaging evaluation.

关 键 词：脑积水 磁共振成像 前瞻性研究 预后 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]