胎儿侧脑室扩张程度与妊娠结局  

Pregnancy outcome and prognosis of fetal lateral ventriculomegaly

作　　者：熊微 李胜利 林清秀 张梅芳 Xiong Wei;Li Shengli;Lin Qingxiu;Zhang Meifang(Department of Ultrasound,Shenzhen Maternity&Child Healthcare Hospital,the First School of Clinical Medicine,Southern Medical University,Shenzhen 518028,China;Department of Radiology,Shenzhen People's Hospital(the Second Clinical Medical College,Jinan University,the First Affiliated Hospital,Southern University of Science and Technology),Shenzhen 518020,China;Department of Ultrasound,Songgang People's Hospital,Shenzhen 518005,China)

机构地区：[1]南方医科大学第一临床医学院,深圳市妇幼保健院超声科,.518028 [2]深圳市人民医院(暨南大学第二附属医院,南方医科大学第一附属医院)医学影像科,518020 [3]深圳市宝安区松岗人民医院超声科,518005

出　　处：《中华医学超声杂志（电子版）》2021年第3期290-295,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的回顾性分析胎儿侧脑室扩张的妊娠结局与预后,并分析超声与MRI在侧脑室扩张诊断中的一致性,进一步探讨超声报告中提示需进一步临床咨询的侧脑室临界值。方法选择2015年1月至2016年12月年深圳市人民医院100例超声诊断为侧脑室扩张或脑积水的单胎连续病例作为观察组,按侧脑室宽度,分为轻度扩张组(>10,≤12 mm;59例)、中度扩张组(>12,≤15 mm;24例)和重度扩张组(>15 mm;17例)。根据是否合并侧脑室扩张以外的病变,分为孤立性侧脑室扩张(IVM)组51例和非孤立性侧脑室扩张(NIVM)组49例。另选择同期141例侧脑室宽度>8 mm,≤10 mm单胎连续病例作为对照组。记录上述病例的临床、实验室、MRI资料及妊娠结局,使用χ^(2)检验分析轻度扩张组、中度扩张组、重度扩张组及对照组间,以及IVM与NIVM组间的妊娠结局与预后是否有差异。采用Kappa检验分析超声与MRI在诊断侧脑室扩张中的一致性。采用受试者操作特征(ROC)曲线分析诊断侧脑室扩张的截断值。结果(1)轻度扩张组、中度扩张组、重度扩张组和对照组出生阳性率分别为6.5%(3/46)、22.2%(2/9)、60.0%(3/5)和5.5%(7/128),差异具有统计学意义(χ^(2)=22.148,P=0.001);IVM和NIVM组异常妊娠结局率分别为33.3%(17/51)、63.3%(31/49),结局差异具有统计学意义(χ^(2)=8.970,P=0.005)。(2)共36例行产前和(或)产后MRI检查,与超声相符率为77.8%(28/36),补充诊断率为19.4%(7/36)。超声与MRI在诊断侧脑室扩张中的一致性一般(Kappa值=0.543,P=0.001)。(3)ROC曲线分析出超声提示的侧脑室诊断截断值为9.7 mm。结论侧脑室扩张越严重,胎儿预后越差;NIVM比IVM预后差。超声与MRI在诊断侧脑室扩张中一致性一般,但MRI对某些类型的异常(如皮质,白质和颅内出血)的补充检出率更高。产前超声是诊断侧脑室扩张的重要手段,侧脑室宽度>9.7 mm时,应提示进一步产前咨询。Objective To retrospectively analyze the pregnancy outcome and prognosis of fetal lateral ventriculomegaly,analyze the consistency of ultrasound and magnetic resonance imaging(MRI)in the diagnosis of lateral ventriculomegaly,and further explore the ultrasound cut-off value of the lateral ventricle for further clinical consultation.Methods A total of 100 consecutive singleton cases diagnosed by ultrasound with lateral ventriculomegaly or hydrocephalus at Shenzhen People's Hospital from January 2015 to December 2016 were selected as an observation group.According to the width of the lateral ventricle,they were divided into a mild group(>10 to≤12 mm,59 cases),moderate group(>12 to≤15 mm,24 cases),and severe group>15 mm,17 cases).The patients were also divided into an isolated ventriculomegaly(IVM)group(51 cases)or a non-isolated ventriculomegaly(NIVM)group(49 cases)according to whether or not they had other diseases.Another 141 consecutive singletons who had a width of the lateral ventricle of>8 mm to≤10 mm were selected as a control group.The clinical,laboratory,and MRI data and pregnancy outcome were recorded.Theχ^(2) test was used to analyze the difference of pregnancy outcome and prognosis among the mild group,moderate group,severe group,and control group and the difference of abnormal pregnancy outcomes between the IVM and NIVM groups.The Kappa test was used to analyze the consistency of ultrasound and MRI in the diagnosis of lateral ventriculomegaly.ROC curve was used to analyze the cut-off value of the ultrasound lateral ventricle.Results The positive rates at birth in the mild group,moderate group,severe group,and control group were 6.5%(3/46),22.2%(2/9),60.0%(3/5),and 5.5%(7/128),respectively,with a statistically significant difference(χ^(2)=22.148,P=0.001).The rate of abnormal pregnancy outcomes in the IVM and NIVM groups were 33.3%(17/51)and 63.3%(31/49),respectively,with a statistically significant difference(χ^(2)=8.970,P=0.005).A total of 36 cases underwent prenatal and/or postnatal MRI examin

关 键 词：产前超声 脑积水 侧脑室扩张 妊娠结局 临界值 

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]