与21三体综合征相关的胎儿胸腔积液的结局及预后因素

The outcomes and prognostic factors of fetal hydrothorax associated with trisomy 21.

作者信息

Yumoto Yasuo, Jwa Seung Chik, Wada Seiji, Takahashi Yuichiro, Ishii Keisuke, Kato Kiyoko, Usui Noriaki, Sago Haruhiko

机构信息

Department of Obstetrics and Gynecology, Kyushu University Hospital, Kyushu University, Fukuoka, Japan.

Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

出版信息

Prenat Diagn. 2017 Jul;37(7):686-692. doi: 10.1002/pd.5066. Epub 2017 May 29.

DOI:10.1002/pd.5066

PMID:28493447

Abstract

OBJECTIVES

To determine the characteristics, outcomes, and prognostic factors of fetal hydrothorax (FHT) with trisomy 21.

METHODS

A nationwide survey was conducted on FHT fetuses with trisomy 21 delivered after 22 weeks' gestation between January 2007 and December 2011 at perinatal centers.

RESULTS

The 91 cases of FHT with trisomy 21 included 28 (30.8%) diagnosed in utero and 63 (69.2%) diagnosed after birth. The natural remission rate was 6.6% (6/91). Thoracoamniotic shunting was performed in 14.3% (13/91) of cases. The survival rates of the hydropic, nonhydropic, and total cases were 47.0% (31/66), 84.0% (21/25), and 57.1% (52/91), respectively. The crude odds ratio for death was 8.2 (p = 0.003) for fetuses diagnosed at 26-30 weeks of gestational age (vs ≥30 weeks), 5.9 (p = 0.003) for hydrops, 4.0 (p = 0.04) for bilateral pleural effusion, 0.68 (p = 0.42) for associated cardiovascular anomalies, and 2.1 (p = 0.26) for thoracoamniotic shunting (vs no fetal therapy).

CONCLUSIONS

The prognosis of FHT with trisomy 21 was not very poor, but it was still worse than that of primary FHT. Hydrops, an early gestational age at the diagnosis and bilateral effusion, but not associated anomalies, were risk factors for death. Fetal therapy showed no survival benefit for FHT with trisomy 21. © 2017 John Wiley & Sons, Ltd.

摘要

目的

确定21三体综合征合并胎儿胸腔积液（FHT）的特征、结局及预后因素。

方法

对2007年1月至2011年12月期间在围产期中心妊娠22周后分娩的21三体综合征合并FHT胎儿进行全国性调查。

结果

91例21三体综合征合并FHT胎儿中，28例（30.8%）在宫内诊断，63例（69.2%）在出生后诊断。自然缓解率为6.6%（6/91）。14.3%（13/91）的病例进行了胸腔羊膜腔分流术。水肿型、非水肿型及全部病例的生存率分别为47.0%（31/66）、84.0%（21/25）和57.1%（52/91）。孕26 - 30周诊断的胎儿（与≥30周相比）死亡的粗比值比为8.2（p = 0.003），水肿型为5.9（p = 0.003），双侧胸腔积液为4.0（p = 0.04），合并心血管异常为0.68（p = 0.42），胸腔羊膜腔分流术（与未进行胎儿治疗相比）为2.1（p = 0.26）。