肺内动脉多普勒对改善胎儿内镜气管封堵术治疗先天性膈疝胎儿存活率预测的作用

Contribution of intrapulmonary artery Doppler to improve prediction of survival in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion.

机构信息

Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.

出版信息

Ultrasound Obstet Gynecol. 2010 May;35(5):572-7. doi: 10.1002/uog.7593.

DOI:10.1002/uog.7593

PMID:20178111

Abstract

OBJECTIVE

To evaluate the contribution of intrapulmonary artery Doppler in predicting the survival of fetuses with congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO).

METHODS

A cohort of 41 fetuses (between 24 and 28 weeks of gestation) with CDH was treated with FETO. The observed/expected lung-to-head ratio (O/E-LHR), pulmonary artery pulsatility index (PI), peak early diastolic reversed flow (PEDRF) and peak systolic velocity (PSV) were evaluated before FETO, and their isolated and combined value to predict survival using multiple logistic regression and decision-tree analysis was assessed.

RESULTS

O/E-LHR and intrapulmonary artery PI and PEDRF were significantly associated with the probability of survival (O/E-LHR > or = 26%, OR 14.2; PI < 1 Z-score, OR 8.4; and PEDRF < 3.5 Z-scores, OR 5.7). Decision-tree analysis showed that O/E-LHR was the best initial predictor of prognosis (O/E-LHR > or = 26%, 90% survival; O/E-LHR < 26%, 45% survival). For fetuses with an O/E-LHR of < 26%, Doppler parameters allowed discrimination of cases with moderate (66-71% survival) and very poor (0% survival) prognosis.

CONCLUSION

Intrapulmonary artery Doppler evaluation helps to refine the prediction of survival after FETO in fetuses with severe CDH.

摘要

目的

评估肺内动脉多普勒在预测接受胎儿镜气管阻塞术（FETO）治疗的先天性膈疝（CDH）胎儿存活率中的作用。

方法

对 41 例（孕 24 至 28 周）CDH 胎儿进行 FETO 治疗。观察/预期肺头比（O/E-LHR）、肺动脉搏动指数（PI）、早期舒张反向峰值流速（PEDRF）和收缩期峰值流速（PSV）在 FETO 前进行评估，并采用多变量逻辑回归和决策树分析评估其单独和联合预测生存率的价值。

结果

O/E-LHR 以及肺内动脉 PI 和 PEDRF 与生存率显著相关（O/E-LHR≥26%，OR 14.2；PI＜1 Z 评分，OR 8.4；PEDRF＜3.5 Z 评分，OR 5.7）。决策树分析显示，O/E-LHR 是预后最佳的初始预测指标（O/E-LHR≥26%，90%生存率；O/E-LHR＜26%，45%生存率）。对于 O/E-LHR＜26%的胎儿，多普勒参数可区分中等（66-71%生存率）和极差（0%生存率）预后的病例。