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目的根据MR成像测量产前胎儿的观察-预期肺容积(FLV)比率的结果来评估幸存的先天性膈疝(CDH)婴儿发生的慢性肺疾病(CLD)是否与肺发育不良有关。材料与方法本研究获机构伦理委员会批准,是一项无需签署知情同意书的回顾性研究,且研究对象此前参加过一项已签署知情同意书的前瞻性研究。在172例先天性膈疝胎儿的MR影像上测量胎儿肺容积,除以据胎龄预测的胎儿肺容积值,计算获得观察-预期FLV比率。在产后28d需要辅助吸氧的患儿确定CLD的诊断。在产后56d,根据对氧气的需求不同,将患儿分成轻度、中度或重度CLD3组。用Logistic回归分析来评估个体患儿观察-预期FLV比率对产后发生CLD情况的预后价值。结果 CLD患儿MR成像测量计算得到的观察-预期FLV比率显著低于无CLD患儿(P<0.001)。CLD严重度分级结果显示轻度CLD患儿与中度、重度CLD患儿的观察-预期FLV比率存在显著性差异(中度P=0.012,重度P=0.007)。观察-预期FLV比率为5%的患儿,99%的CDH患儿发展为CLD;而观察-预期FLV比率为50%的患儿,发生CLD的比例不足5%。在围产期,体外膜肺氧合(ECMO)的需求(P<0.001)和分娩孕周(P=0.009)对CLD的发展和严重度分级有进一步的影响。结论 CDH幸存患儿的CLD表现与产前测定的观察-预期FLV比率有相关性。产前观察-预期FLV比率可作为决定新生儿早期治疗方案的额外参考。围产期,ECMO需求和分娩孕周有助于进一步提高CLD估测的准确性。
OBJECTIVE: To assess whether the development of chronic lung disease (CLD) in a surviving congenital diaphragmatic hernia (CDH) infants is associated with pulmonary dysplasia based on the results of MR imaging of prenatal fetal observation-expected lung volume (FLV) ratio. Materials and Methods The study, approved by the Institutional Ethics Committee, was a retrospective study without signed informed consent and the subject previously participated in a prospective study with signed informed consent. Fetal lung volume was measured on MR images of 172 congenital diaphragmatic hernia fetuses and divided by the fetal lung volume predicted from gestational age to calculate the observed-to-expected FLV ratio. The diagnosis of CLD was confirmed in children requiring assisted oxygenation at 28 days postpartum. On postnatal day 56, children were divided into mild, moderate, or severe CLD3 groups, depending on their oxygen demand. Logistic regression analysis was used to assess the prognostic value of the observed-expected FLV rate in individuals with CLD on postpartum outcomes. Results Observations calculated from MR imaging measurements in children with CLD-expected FLV rates were significantly lower in children without CLD (P <0.001). CLD severity grading results showed that there was a significant difference in the expected FLV rate (moderate P = 0.012, severe P = 0.007) in children with mild CLD and those with moderate and severe CLD. Observations - 99% of children with CDH who develop FLD at a FLV rate of 5% are expected to develop CLD; and - at a rate of less than 5% of children with an FLV rate of 50%. During perinatal period, the need for extracorporeal membrane oxygenation (ECMO) (P <0.001) and gestational weeks of delivery (P = 0.009) further have implications for CLD development and severity grading. Conclusions CLD performance in children with CDH survivors is correlated with the observation of prenatal determination of expected FLV rates. Prenatal Observations - The expected FLV ratio can be used as an additional reference for determining early neonatal treatment regimens. The perinatal period, ECMO needs and gestational weeks of childbirth help to further improve the accuracy of CLD estimates.