先天性肺气道畸形胎儿不良预后危险因素的CVR阈值研究  

Threshold of congenital pulmonary airway malformation-volume ratio in determining the poor prognostic risk factors of fetuses with congenital pulmonary airway malformations

作　　者：杨君婷 刘彩霞[2] 李青 秦珍珍 文云红 刘一为 杨元恺 王嘉 张泽宇 Yang Junting;Liu Caixia;Li Qing;Qin Zhenzhen;Wen Yunhong;Liu Yiwei;Yang Yuankai;Wang Jia;Zhang Zeyu(Department of Pediatrics,Shanxi Medical University,Taiyuan 030001,China;Department of Cardiothoracic Surgery,Shanxi Childre's Hospital,Taiyuan 030025,China)

机构地区：[1]山西医科大学儿科医学系,太原030001 [2]山西省儿童医院心胸外科,太原030025

出　　处：《中华小儿外科杂志》2025年第2期114-120,共7页Chinese Journal of Pediatric Surgery

基　　金：山西省留学回国人员科技活动择优资助项目(20210031)。

摘　　要：目的探讨先天性肺气道畸形体积比(congenital pulmonary airway malformation-volume ratio,CVR)对先天性肺气道畸形(congenital pulmonary airway malformation,CPAM)胎儿不良预后危险因素的最佳预测阈值。方法回顾性分析山西省儿童医院2012年1月至2022年10月诊断为CPAM的278例患儿的产前超声资料及妊娠结局,根据胎儿不良预后的危险因素(胎儿水肿、纵隔移位及生后呼吸困难)分组,使用Wilcoxon两样本秩和检验和Fisher确切概率法分别进行组间初次CVR、最大CVR和预后比较,对差异有统计学意义的CVR绘制ROC曲线,获得最佳预测阈值。结果278例产前超声诊断为CPAM的中位胎龄为23.86(22.71,24.57)周;病变位于左侧136例,右侧137例,双侧5例;CVR>1.6的患儿共35例,其中5例结局资料缺失,终止妊娠14例,余16例出生胎儿全部存活,并发呼吸困难3例。胎儿水肿组最大CVR值高于无胎儿水肿组[2.40±1.52比0.71(0.32,1.20),P<0.01)]、胎儿水肿组生后呼吸困难人数百分比高于无胎儿水肿组(60%比9.3%,P<0.05)。纵隔移位组胎儿初次CVR值[0.76(0.55,1.14)比0.31(0.16,0.66),P<0.01)]、最大CVR值[1.35(0.97,1.80)比0.47(0.25,0.95),P<0.01]、生后呼吸困难人数百分比(24.2%比6.3%,P<0.05)均明显高于无纵隔移位组。呼吸困难组胎儿水肿人数百分比(23.1%比2.0%,P<0.05)、纵隔移位人数百分比(61.5%比25.3%,P<0.05)及死亡人数百分比(15.4%比0%,P<0.05)均高于无呼吸困难组。预测胎儿水肿的最大CVR阈值为1.67;预测胎儿纵隔移位的初次CVR及最大CVR阈值分别为0.44、1.00。结论最大CVR预测胎儿水肿价值较大,初次CVR及最大CVR均可以较好地预测胎儿纵隔移位,临床医生可以使用CVR并结合胎儿是否存在水肿和(或)纵隔移位对孕母提出积极性建议。ObjectiveTo investigate the optimal threshold of the congenital pulmonary airway malformation-volume ratio(CVR)as a risk factor for adverse outcomes in fetuses with congenital pulmonary airway malformation(CPAM).MethodsThe prenatal ultrasound data and pregnancy outcomes of 278 children diagnosed with congenital pulmonary airway malformation(CPAM)in Shanxi Children's Hospital between January 2012 and October 2022 were retrospectively analyzed.The patients were grouped according to the risk factors for poor prognosis(mediastinal shift,fetal hydrops and postnatal dyspnea).Wilcoxon two-sample rank sum test and Fisher's exact test were used to compare primary CVR,maximum CVR and prognosis between groups.Receiver operating characteristics(ROC)curves of CVR with statistical differences between groups were plotted to obtain the optimal threshold.ResultsThe gestational age at diagnosis for 278 CPAM patients was 23.86(22.71,24.57)weeks.Left-sided,right-sided and bilateral lesions were detected in 136,137 and 5 cases,respectively.There were 35 cases with CVR>1.6,including 5 with missing outcome data,and 14 with termination of pregnancy.The remaining 16 fetuses survived and 3 were complicated with dyspnea after birth.The maximum CVR value in the hydrops group was significantly higher than that in the non-hydrops group(2.40±1.52 vs.0.71[0.32,1.20],P<0.01),and the percentage of dyspnea in the hydrops group was significantly higher than that in the non-hydrops group(60%vs.9.3%,P<0.05).In the mediastinal shift group,the primary CVR value(0.76[0.55,1.14]vs.0.31[0.16,0.66],P<0.01),the maximum CVR value(1.35[0.97,1.80]vs.0.47[0.25,0.95],P<0.01),and the percentage of patients with dyspnea after birth(24.2%vs.6.3%,P<0.05)were significantly higher than those in the non-mediastinal shift group.The percentage of hydrops(23.1%vs.2.0%,P<0.05),the percentage of mediastinal shift(61.5%vs.25.3%,P<0.05)and mortality(15.4%vs.0,P<0.05)in dyspnea group were significantly higher than those in non-dyspnea one.The maximum CVR threshold for predict

关 键 词：肺囊腺瘤样畸形 先天性 胎儿水肿 呼吸困难 纵隔移位 

分 类 号：R714.53[医药卫生—妇产科学]