胎儿期MRI测量预测肺容积比对左侧先天性膈疝患儿预后的诊断价值  

Diagnostic value of MRI-measured fetal percent predicted lung volume for prognosis of left congenital diaphragmatic hernia

作　　者：吕俊健 何秋明 钟微 文豪 黄莉 王哲 吴强 余家康 刘鸿圣 Lyu Junjian;He Qiuming;Zhong Wei;Wen Hao;Huang Li;Wang Zhe;Wu Qiang;Yu Jiakang;Liu Hongsheng(Fetal Medical Center,Women and Children＇s Medical Center of Guangzhou,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心胎儿医学中心,510623

出　　处：《中华围产医学杂志》2018年第11期745-749,共5页Chinese Journal of Perinatal Medicine

基　　金：广东省科技计划项目（2014A020212025）;广州市医药卫生科技项目（2015A010033）

摘　　要：目的探讨胎儿期MRI测量预测肺容积比（percent predicted lung volume．PPLv）对左侧先天性膈疝（congenital diaphragmatic hernia，CDH）患儿预后的诊断价值。方法回顾性分析2012年9月至2017年12月收治的经广州市妇女儿童医疗中心产前评估及诊断的32例左侧CDH患儿资料。根据生后行膈肌修补术后30d结局分为存活组24例和死亡组8例；根据患儿是否发生持续肺动脉高压（pulmonary hypertension，PH）分为无PH组20例和PH组12例。采用t检验或Fisher精确概率法比较不同组患儿的胎龄、出生体重、Apgar评分等一般资料及胎儿期MRI测量的PPLV值，并绘制32例患儿胎儿期MRI PPLV值受试者工作特性（receiver operating characteristic，ROC）曲线。结果（1）存活组胎儿期PPLV值为（39．5±2．5）％，明显高于死亡组（20．4±2．1）％（t=4．27）；膈疝首诊孕周晚于死亡组[（31．6±4．2）与（25．4±4．6）周，t=3．40]；5minApgar评分高于死亡组[（8．7±1．5）与（5．7±3．8）分，t=3．26]；PH发生率低于死亡组[16．7％（4／24）与8／8]，差异均有统计学意义（P值均〈O．01）。对32例患儿死亡预测的PPLV值的ROC曲线下面积为0．930（95％CI：0．843-1．016，P〈0．01）；PPLV为28．55％时对CDH患儿死亡的预测敏感度为100％，特异度为79％。（2）无PH组胎儿期PPLV值为（41．7±2．6）％，明显高于PH组（23．0±2．0）％（t=4．98）；膈疝首诊孕周晚于PH组[（32．3±3．4）与（26．3±5．2）周，t=3．81]；5min Apgar评分高于PH组[（8．6±1．4）与（6．8±2．5）分，t=2．62]；病死率低于PH组[0（0／20）与8／12]，差异均有统计学意义（P值均〈0．01）。对32例患儿发生PH预测的PPLV值的ROC曲线下面积为0．902（95％CI：0．800-1．004，P〈0．01）；PPLV界值为33．67％时对发生PH预测的敏感度为100％，特异度为75％。结论胎儿期MRI测量PPLV值可作为左侧CDH�Objective To evaluate the diagnostic value of MRI-measured fetal percent predicted lung volume （PPLV） for the prognosis of left congenital diaphragmatic hernia （CDH） in fetus. Methods Clinical data of 32 children who were admitted to Women and Children＇s Medical Center of Guangzhou from September 2012 to December 2017 for prenatally diagnosed left CDH were retrospectively analyzed. These children were divided into two groups, the survival group （n=24） and the death group （n=8）, according to the postoperative outcomes at 30 days after CDH repair. Moreover, they were also divided into non-pulmonary hypertension （non- PH） group （n=20） and PH group （n=12）, based on whether they suffered from PH or not. Clinical data such as gestational age, birth weight, Apgar score and PPLV values in different groups were compared with t-or Fisher＇s exact test. The receiver operating characteristic （ROC） curve of the MRI-measured fetal PPLV values of the 32 children was plotted. Results （1） Comparing with the death group, fetal PPLV was significantly higher [（39.5 ±2.5）% vs （20.4± 2.1）%, t=4.27], the gestations on initial diagnosis of CDH was later [（31.6±4.2） vs （25.4±4.6） gestational weeks, t=-3.40], Apgar score of the neonates at 5 min was higher （8.7±1.5 vs 5.7±3.8, t=-3.26）, and fewer cases of PH were reported in the survival group [16.7% （4/24） and 8/8], all P〈0.01. The area under the ROC curve of PPLV values for mortality prediction was 0.930 （95%CI： 0.843-1.016, P〈0.01）. When the PPLV value was 28.55%, its sensitivity and specificity for death prediction in children with left CDH were 100% and 79%, respectively. （2） Comparing with the PH group, fetal PPLV was significantly higher [（41.7 ± 2.6）% vs （23.0 ±2.0）%, t=4.98], the gestations on initial diagnosis of CDH was later [（32.3 ±3.4） vs （26.3 ±5.2） gestational weeks, t=3.81], neonatal Apgar score at 5 min was higher （8.6± 1.4 vs 6.8±2.5, t=-2.62） and death rate was

关 键 词：疝 横膈  先天性 肺容量测定 磁共振成像 产前诊断 

分 类 号：R726.5[医药卫生—儿科] R445.2[医药卫生—临床医学]