Laudy J A M, Van Gucht M, Van Dooren M F, Wladimiroff J W, Tibboel D
Department of Obstetrics and Gynaecology, Division of Prenatal Diagnosis, Erasmus MC, Rotterdam, The Netherlands.
Prenat Diagn. 2003 Aug;23(8):634-9. doi: 10.1002/pd.654.
A retrospective analysis of the prognostic significance of the lung-to-head ratio (LHR) and other prenatal parameters on the outcome of fetuses with left-sided congenital diaphragmatic hernia (CDH).
A total of 26 fetuses with isolated left CDH without chromosomal abnormalities were included. Twenty-one LHR measurements could retrospectively be calculated from the last available ultrasonographic recordings before birth. The relationship between LHR and fetal outcome and the gestational age dependency of this relation was tested. Cutoff levels as previously published were applied to determine their predictive value in this population. The association between other prenatal predictive variables and fetal outcome was also determined. Survival was defined as discharge from the hospital.
The overall survival rate was 50%. There was a statistically significant difference between the mean LHR of the survivors compared to the mean LHR of the nonsurvivors (1.78 vs 1.02), whereas the mean gestational age of these two groups did not differ. LHR was not gestational age dependent in the prediction of fetal outcome. The cutoff levels LHR <1, 1-1.4, >1.4 showed a good applicability in the prediction of fetal outcome within the present study population with a 100% survival if LHR >1.4 and a 100% mortality if LHR <1. An intrathoracic position of the stomach, mediastinal shift, polyhydramnios as individual variables and early diagnosis (<25 weeks' gestation) revealed to be poor sonographic predictors for fetal outcome.
LHR proved to be a good predictor for fetal outcome, independent of gestational age at the time of the measurement. To substantiate our observation, a prospective multicenter study is warranted.
回顾性分析肺头比（LHR）及其他产前参数对左侧先天性膈疝（CDH）胎儿预后的意义。
纳入26例无染色体异常的孤立性左侧CDH胎儿。可从出生前最后一次可用超声记录中回顾性计算出21例的LHR测量值。测试LHR与胎儿结局之间的关系以及该关系对孕周的依赖性。应用先前公布的临界值来确定其在该人群中的预测价值。还确定了其他产前预测变量与胎儿结局之间的关联。生存定义为出院。
总体生存率为50%。存活者的平均LHR与非存活者的平均LHR之间存在统计学显著差异（1.78对1.02），而这两组的平均孕周无差异。在预测胎儿结局方面，LHR不依赖于孕周。在本研究人群中，临界值LHR<1、1 - 1.4、>1.4在预测胎儿结局方面显示出良好的适用性，LHR>1.4时生存率为100%，LHR<1时死亡率为100%。胃位于胸腔内、纵隔移位、羊水过多作为个体变量以及早期诊断（妊娠<25周）被证明是胎儿结局较差的超声预测指标。
LHR被证明是胎儿结局的良好预测指标，与测量时的孕周无关。为证实我们的观察结果，有必要进行一项前瞻性多中心研究。
