不同胎儿先天性肺气道畸形容积比病例的临床特点及孕期母体糖皮质激素治疗效果  

Clinical characteristics and effects of maternal glucocorticoid treatment during pregnancy in cases with different fetal congenital pulmonary airway malformation volume ratios

作　　者：王链链 唐慧荣 王娅 戴晨燕[1] 李洁[1] 潘玮辰 王小宇 郑明明[1] Wang Lianian;Tang Huirong;Wang Ya;Dai Chenyan;Li Jie;Pan Weichen;Wang Xiaoyu;Zheng Mingming(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,南京210008

出　　处：《中华围产医学杂志》2024年第8期624-630,共7页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨不同胎儿先天性肺气道畸形(congenital pulmonary airway malformations,CPAM)容积比(CPAM volume ratio,CVR)病例的临床特点,以及孕期母体糖皮质激素治疗CPAM的效果。方法回顾性纳入2020年9月至2023年5月南京大学医学院附属鼓楼医院妇产科产前诊断的胎儿CPAM孕妇56例(均为单胎妊娠),其中3例接受孕期母体糖皮质激素治疗。详细介绍接受孕期母体糖皮质激素治疗病例的临床情况。采用两独立样本t检验、非参数检验、χ^(2)检验或Fisher精确概率法进行统计学分析。结果(1)一般情况:56例胎儿CPAM孕妇年龄(32.0±0.7)岁,所有胎儿均为单侧病变,其中左侧25例(44.6%),Ⅰ、Ⅱ、Ⅲ型CPAM分别占5.4%(3/56)、50.0%(28/56)和44.6%(25/56)。56例中发生胎儿水肿2例,非水肿胎儿的胎儿期最大CVR为0.79±0.66。(2)以非水肿CPAM胎儿的最大CVR平均值加2个标准差作为胎儿水肿发生风险的CVR阈值(0.79+2×0.66=2.1),将研究对象根据胎儿期最大CVR分为CVR≤2.0组(n=50)及CVR>2.0组(n=6)。CVR>2.0组与CVR≤2.0组相比,胎儿水肿[2/6与0.0%(0/50),Fisher精确概率法]、纵隔移位[5/6与32.0%(16/50),χ^(2)=4.03]、羊水过多[6/6与4.0%(2/50),Fisher精确概率法]和生后手术治疗的比例均较高[4/5与22.2%(10/45),连续校正χ^(2)=4.86],差异均有统计学意义(P值均<0.05)。CVR≤2.0的胎儿均未合并水肿,均未接受宫内干预。总体活产率为89.3%(50/56)。(3)孕期母体糖皮质激素治疗情况:6例CVR>2.0的胎儿中3例接受孕期母体糖皮质激素治疗,干预后水肿缓解和/或肿块体积减小,均足月活产分娩。其中2例生后行胸腔镜手术干预,分别随访至5和14月龄,喂养发育未见异常;另1例随访至3月龄时暂未手术干预,无呼吸道相关症状,喂养发育未见异常。结论产前超声提示CVR>2.0时,胎儿水肿、纵隔移位、羊水过多的发生率增加。对于这类CPAM胎儿,孕期母体糖皮质激素治疗有望获得较好妊娠结局。ObjectiveTo investigate the clinical characteristics of cases with different congenital pulmonary airway malformations(CPAM)volume ratios(CVR)and the effect of maternal glucocorticoid treatment during pregnancy on CPAM.MethodsA retrospective study was conducted on 56 singleton pregnant women with fetal CPAM diagnosed prenatally in the Department of Obstetrics and Gynecology at Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,from September 2020 to May 2023.Among these,three cases received maternal glucocorticoid treatment during pregnancy and clinical conditions were reported in detail.Statistical analyses were performed using independent sample t-tests,non-parametric tests,Chi-square tests,or Fisher's exact test.Results(1)General information:The average age of the 56 pregnant women with CPAM fetuses was(32.0±0.7)years.All fetuses had unilateral lesions,with 25 cases(44.6%)on the left side.TypesⅠ,Ⅱ,andⅢCPAM accounted for 5.4%(3/56),50.0%(28/56),and 44.6%(25/56),respectively.Fetal hydrops occurred in two cases,and the maximum CVR during the fetal period for the other 54 non-hydropic fetuses was 0.79±0.66.(2)The CVR threshold for the risk of fetal hydrops was set as the mean maximum CVR of non-hydropic CPAM fetuses plus 2 standard deviations(0.79+2×0.66=2.1).The subjects were divided into two groups based on the maximum CVR during the fetal period:CVR≤2.0 group(n=50)and CVR>2.0 group(n=6).Comparison between the CVR>2.0 group and CVR≤2.0 group:The CVR>2.0 group had significantly higher rates of fetal hydrops[2/6 vs.0.0%(0/50),Fisher's exact test],mediastinal shift[5/6 vs.32.0%(16/50),χ^(2)=4.03],polyhydramnios[6/6 vs.4.0%(2/50),Fisher's exact test],and postnatal surgery[4/5 vs.22.2%(10/45),continuity correctionχ^(2)=4.86](all P<0.05).None of the fetuses with CVR≤2.0 had hydrops or received intrauterine intervention.The overall live birth rate was 89.3%(50/56).(3)Maternal glucocorticoid treatment during pregnancy:three of six fetuses with CVR>2.0 were treated with

关 键 词：先天性囊性腺瘤样畸形 先天性肺气道畸形 糖皮质激素治疗 宫内治疗 

分 类 号：R714.5[医药卫生—妇产科学]