Li Y, Yin S, Fang J, Hua Y, Wang C, Mu D, Zhou K
Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Ultrasound Obstet Gynecol. 2015 Jun;45(6):639-48. doi: 10.1002/uog.13436.
No consensus has been reached regarding whether brain injury related to congenital heart disease (CHD) is caused by infant cardiac surgery and/or prenatal injury resulting from the CHD. We performed this meta-analysis to identify the likely cause of neurodevelopmental delay in CHD patients.
We carried out a literature search without language restriction in December 2013, retrieving records from PubMed, EMBASE, the Cochrane Library and the World Health Organization trials center, to identify studies applying functional magnetic resonance imaging (fMRI) evaluation of brain function before surgery and, in some cases, after surgery (both immediate term and short term postoperatively). The preoperative and postoperative fMRI results were extracted, and meta-analysis was performed using Revman 5.1.1 and STATA 11.0, according to the guidelines from the Cochrane review and MOOSE groups.
The electronic search yielded 937 citations. Full text was retrieved for 15 articles and eight articles (nine studies) were eligible for inclusion: six studies (n = 312 cases) with fMRI analysis before surgery and three (n = 36 cases) with complete perioperative fMRI analysis. The overall average diffusivity of CHD cases was significantly higher than that of controls, with a summarized standard (std) mean difference of 1.39 (95% CI, 0.70-2.08), and the fractional anisotropy was lower in CHD cases, with a summarized mean difference of -1.43 (95% CI, -1.95 to -0.91). N-acetylaspartate (NAA)/choline (Cho) for the whole brain was significantly lower in CHD cases compared with healthy ones, while lactate/Cho was significantly higher in CHD cases. Immediate term postoperatively, significant changes in NAA/creatine and NAA/Cho, relative to preoperative values, were found. However, the difference did not persist at the short-term follow-up.
This meta-analysis suggests that the delay in neurological development in newborns with CHD is due mainly to prenatal injury, and cardiac surgery might lead to mild brain injuries postoperatively, but fMRI shows recovery within a short period.
关于先天性心脏病（CHD）相关的脑损伤是由婴儿心脏手术和/或CHD导致的产前损伤引起的，目前尚未达成共识。我们进行了这项荟萃分析，以确定CHD患者神经发育延迟的可能原因。
2013年12月，我们进行了一项无语言限制的文献检索，从PubMed、EMBASE、Cochrane图书馆和世界卫生组织试验中心检索记录，以确定在手术前以及在某些情况下手术后（术后即刻和短期）应用功能磁共振成像（fMRI）评估脑功能的研究。提取术前和术后的fMRI结果，并根据Cochrane综述和MOOSE小组的指南，使用Revman 5.1.1和STATA 11.0进行荟萃分析。
电子检索产生了937条引文。检索了15篇文章的全文，其中8篇文章（9项研究）符合纳入标准：6项研究（n = 312例）进行了手术前的fMRI分析，3项研究（n = 36例）进行了完整的围手术期fMRI分析。CHD病例的总体平均扩散率显著高于对照组，汇总标准（std）平均差为1.39（95%CI，0.70 - 2.08），CHD病例的分数各向异性较低，汇总平均差为 -1.43（95%CI，-1.95至 -0.91）。与健康人相比，CHD病例全脑的N - 乙酰天门冬氨酸（NAA）/胆碱（Cho）显著降低，而CHD病例的乳酸/胆碱显著升高。术后即刻，相对于术前值，NAA/肌酸和NAA/Cho有显著变化。然而，在短期随访中这种差异并未持续存在。
这项荟萃分析表明，CHD新生儿神经发育延迟主要是由于产前损伤，心脏手术可能导致术后轻度脑损伤，但fMRI显示在短期内可恢复。
