摘要
目的探讨单纯性双侧侧脑室轻度和中度扩张胎儿出生后神经系统发育状况。方法收集2013年5月至2017年6月在浙江省湖州市妇幼保健院经产前超声和MRI均诊断为单纯性侧脑室扩张,且扩张程度一致的244例单胎胎儿,包括双侧扩张组82例和单侧扩张组162例,根据扩张程度进一步分为轻度扩张组(侧脑室宽度10.0~12.0 mm,双侧56例,单侧120例)和中度扩张组(侧脑室宽度>12.0~<15.0 mm,双侧26例,单侧42例)。另纳入同期经产前神经系统超声和MRI均未见异常的单胎胎儿50例作为对照。所有研究对象生后1周内复查超声,并分别于3、6、12、18个月随访,采用Gesell发育量表(Gesell Development Schedules,GDS)评估中枢神经系统功能,观察侧脑室扩张的变化。采用t、F或χ^2检验(或Fisher精确概率法)进行统计学分析。结果(1)双侧、单侧扩张组和对照组MRI检查到分娩的时间差异无统计学意义。双侧轻度扩张组生后侧脑室扩张消失率为80.4%(45/56),双侧中度扩张组为42.3%(11/26),单侧轻度扩张组为88.3%(106/120),单侧中度扩张组为57.1%(24/42)(χ^2=35.183,P<0.001)。(2)双侧扩张组生后6、12、18月GDS评价结果较单侧扩张组差(P值均<0.0167)。双侧扩张组生后3、6月GDS评价结果较对照组差[3月龄正常:58.5%(48/82)与86.0%(43/50),临界:22.0%(18/82)与10.0%(5/50),落后:19.5%(16/82)与4.0%(2/50),χ^2=11.425;6月龄正常:63.4%(52/82)与88.0%(44/50),临界:19.5%(16/82)与8.0%(4/50),落后:17.1%(14/82)与4.0%(2/50),χ^2=9.678;P值均<0.0167]。(3)双侧中度扩张组生后6、12、18个月GDS评价结果较单侧中度扩张组差[6月龄正常:30.8%(8/26)与69.0%(29/42),临界:30.8%(8/26)与21.4%(9/42),落后:38.5%(10/26)与9.5%(4/42),χ^2=11.417;12月龄正常:53.8%(14/26)与88.1%(37/42),临界:23.1%(6/26)与9.5%(4/42),落后:23.1%(6/26)与2.4%(1/42)与,χ^2=11.199;18月龄正常:65.4%(17/26)与95.2%(40/42),临界:15.4%(4/26)与2.4%(1/42),落后:19.2%(5/26)与2.4%(1/42),χ^2=10.568;P值均<0.0167]。双侧中度扩张组生后3、6、12、18个月GDS评价结果较对照组差(P值均<0.0167)。(4)双侧扩张组生后18个月的GDS评价结果好于3个月(χ^2=8.224,P=0.016)。结论(1)双侧轻度扩张组生后,扩张的侧脑室多倾向于消失。双侧轻度扩张组的侧脑室扩张消失率略小于单侧。(2)双侧侧脑室扩张胎儿生后GDS评价结果在6个月后明显落后于单侧侧脑室扩张组。(3)单纯性双侧侧脑室扩张程度越轻,胎儿生后GDS评价结果改善的可能性越大。
Objective To explore the value of prenatal MRI in the diagnosis of isolated mild and moderate bilateral ventriculomegaly and neural development of the fetuses after birth.Methods This is a retrospective study involving 244 singleton fetuses with isolated mild or moderate lateral ventriculomegaly diagnosed by both prenatal ultrasound and MRI in Huzhou Maternity&Child Health Care from May 2013 to June 2017,consisting of 82 cases with bilateral ventriculomegaly(BVM)and 162 with unilateral ventriculomegaly(UVM).The two groups were further divided into two subgroups:mild(lateral ventricle width:10.0-12.0 mm,bilateral 56 cases,unilateral 120 cases)and moderate group(lateral ventricle width:>12.0-<15.0 mm,bilateral 26 cases,unilateral 42 cases).In addition,50 singleton fetuses without any abnormality in the nervous system in prenatal check were included in the control group during the same period.All neonates were reexamined by ultrasound within one week after birth,and followed up regularly at the age of 3,6,12 and 18 months.Gesell Development Schedules(GDS)were used to evaluate the central nervous system's function,and postnatal changes in lateral ventriculomegaly were observed.Statistical analysis was performed by t,F,Chi-square tests(or Fisher's exact test).Results(1)There was no difference among intervals between MRI scan and delivery in the BVM,UVM,and the control groups.The disappearance rate of lateral ventriculomegaly after birth was 80.4%(45/56)in the mild BVM group,42.3%(11/26)in the moderate BVM group,88.3%(106/120)in the mild UVM group,and 57.1%(24/42)in the moderate UVM group(χ^2=35.183,P<0.001).(2)The GDS evaluation results in the BVM group at 6,12,and 18 months after birth were worse than those in the UVM group(all P<0.0167).The GDS evaluation results in the BVM group were worse than those in the control group at 3 and 6 months after birth[3 months:normal:58.5%(48/82)vs 86.0%(43/50),borderline:22.0%(18/82)vs 10.0%(5/50),delay:19.5%(16/82)vs 4.0%(2/50),χ^2=11.425;6 months:normal:63.4%(52/82)vs 88.0%(44/50),borderline:19.5%(16/82)vs 8.0%(4/50),delay:17.1%(14/82)vs 4.0%(2/50),χ^2=9.678;all P<0.0167].(3)The GDS evaluation results in the moderate BVM group at 6,12,and 18 months after birth were worse than those in the moderate UVM group[6 months:normal:30.8%(8/26)vs 69.0%(29/42),borderline:30.8%(8/26)vs 21.4%(9/42),delay:38.5%(10/26)vs 9.5%(4/42),χ^2=11.417;12 months:normal:53.8%(14/26)vs 88.1%(37/42),borderline:23.1%(6/26)vs 9.5%(4/42),delay:23.1%(6/26)vs 2.4%(1/42),χ^2=11.199;18 months:normal:65.4%(17/26)vs 95.2%(40/42),borderline:15.4%(4/26)vs 2.4%(1/42),delay:19.2%(5/26)vs 2.4%(1/42),χ^2=10.568;all P<0.0167].The GDS evaluation results of the moderate BVM group at 3,6,12,and 18 months after birth were worse than the control group.(4)In the BVM group,the GDS scores at 18 months of age were better than those at three months of age(χ^2=8.224,P=0.016).Conclusions(1)Most mild BVM would disappear spontaneously after birth,while more in mild UVM cases.(2)The postnatal GDS evaluation results of the BVM group is significantly worse than that of the UBM group at months of age;(3)Fetuses with less severe isolated BVM are more likely to have improved GDS score after birth.
作者
李志
潘黎明
方嵘
李琼珊
刘玉琴
戚凌红
费敬英
罗志琴
赖灿
Li Zhi;Pan Liming;Fang Rong;Li Qiongshan;Liu Yuqin;Qi Linghong;Fei Jingying;Luo Zhiqin;Lai Can(Department of Radiology,Children’s Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Radiology,Huzhou Maternity&Child Health Care,Huzhou 313000,China;Department of Children's Health,Huzhou Maternity&Child Health Care,Huzhou 313000,China;Department of Obstetrics,Huzhou Maternity&Child Health Care,Huzhou 313000,China;Department of Statistics,Huzhou Maternity&Child Health Care,Huzhou 313000,China;Department of Ultrasound,Huzhou Maternity&Child Health Care,Huzhou 313000,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2020年第11期750-756,共7页
Chinese Journal of Perinatal Medicine
基金
浙江省湖州市科技计划(2014GY11、2018GYB75)。
关键词
脑积水
磁共振成像
产前诊断
随访研究
Hydrocephalus
Magnetic resonance imaging
Prenatal diagnosis
Follow-up studies
