MOMS试验结果与同期单机构产后闭合队列的比较。
A comparison of the MOMS trial results to a contemporaneous, single-institution, postnatal closure cohort.
作者信息
Laskay Nicholas M B, Arynchyna Anastasia A, McClugage Samuel G, Hopson Betsy, Shannon Chevis, Ditty Benjamin, Wellons John C, Blount Jeffrey P, Rocque Brandon G
机构信息
Department of Neurological Surgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham, 1600 7th Ave. S, Lowder 400, Birmingham, AL, 35233, USA.
Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.
出版信息
Childs Nerv Syst. 2017 Apr;33(4):639-646. doi: 10.1007/s00381-016-3328-3. Epub 2016 Dec 27.
PURPOSE
We evaluate a single-institution cohort of mothers contemporaneous with the Management of Myelomeningocele Study (MOMS) trial to determine the generalizability of MOMS results and compare shunt rates.
METHODS
A retrospective chart review identified patients with myelomeningocele born between 2003 and 2009. We applied MOMS eligibility criteria and compared sociodemographic variables between patients at our institution who would have been eligible or ineligible and MOMS participants. Finally, we applied the original MOMS primary outcome and the revised primary outcome to our cohort.
RESULTS
Of the 78 patients, 55 (70.5%) were eligible for the MOMS trial. Mean maternal age, race, and marital status were different from both MOMS groups. Comparing our series to MOMS postnatal shows fewer female infants (44.9 vs. 63.8%, p = 0.017) and more thoracic lesions (12.8 vs. 3.8%, p = 0.038). Shunt rates in our cohort (84.6%) were higher than MOMS prenatal and similar to MOMS postnatal (44.0 and 83.7%, respectively). Fewer children met the original primary outcome than the postnatal group (84.6 vs. 97.8%, p = 0.002). There was no significant difference between our cohort and the prenatal group (84.6 vs. 72.5%, p = 0.058). When applying the revised criteria, we find the opposite: a significant difference between local and MOMS prenatal (84.6 vs. 49.5%, p < 0.001) but no difference between the local group and MOMS postnatal (84.6 vs. 87.0%, p = 0.662).
CONCLUSIONS
Mothers in our cohort differ from mothers enrolled in MOMS via several sociodemographic factors. Baseline fetal characteristics show a significantly higher functional lesion level in between our cohort and MOMS. Treatment of hydrocephalus in our series tracks almost identically with original MOMS shunt criteria. Revision of the criteria led to greater concordance between meeting criteria and receiving a shunt in MOMS patients, but changes the results in our series.
目的
我们评估了一个与脊髓脊膜膨出症治疗研究（MOMS）试验同期的单机构母亲队列，以确定MOMS结果的可推广性并比较分流率。
方法
通过回顾性病历审查确定了2003年至2009年出生的脊髓脊膜膨出症患者。我们应用了MOMS纳入标准，并比较了本机构中符合或不符合条件的患者与MOMS参与者之间的社会人口统计学变量。最后，我们将原始的MOMS主要结局和修订后的主要结局应用于我们的队列。
结果
在78例患者中，55例（70.5%）符合MOMS试验条件。平均母亲年龄、种族和婚姻状况与MOMS的两个组均不同。将我们的系列与MOMS产后组进行比较，发现女婴较少（44.9%对63.8%，p = 0.017），胸段病变较多（12.8%对3.8%，p = 0.038）。我们队列中的分流率（84.6%）高于MOMS产前组，与MOMS产后组相似（分别为44.0%和83.7%）。达到原始主要结局的儿童比产后组少（84.6%对97.8%，p = 0.002）。我们的队列与产前组之间无显著差异（84.6%对72.5%，p = 0.058）。应用修订后的标准时，我们发现情况相反：本地组与MOMS产前组之间存在显著差异（84.6%对49.5%，p < 0.001），但本地组与MOMS产后组之间无差异（84.6%对87.0%，p = 0.662）。
结论
我们队列中的母亲在几个社会人口统计学因素方面与参加MOMS的母亲不同。基线胎儿特征显示我们的队列与MOMS之间功能性病变水平显著更高。我们系列中脑积水的治疗几乎与原始的MOMS分流标准一致。标准的修订导致MOMS患者在符合标准与接受分流之间的一致性更高，但改变了我们系列中的结果。
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