产前磁共振成像检测到的与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）变异相关的异常：一项前瞻性病例对照研究。
SARS-CoV-2 variant-related abnormalities detected by prenatal MRI: a prospective case-control study.
作者信息
Kienast Patric, Prayer Daniela, Binder Julia, Prayer Florian, Dekan Sabine, Langthaler Eva, Sigl Benjamin, Eichinger Sabine, Perkmann-Nagele Nicole, Stuempflen Ingrid, Stuempflen Marlene, Schirwani Nawa, Pateisky Petra, Mitter Christian, Kasprian Gregor
机构信息
Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
出版信息
Lancet Reg Health Eur. 2023 Mar;26:100587. doi: 10.1016/j.lanepe.2023.100587. Epub 2023 Jan 21.
BACKGROUND
There are known complications for fetuses after infection with SARS-CoV-2 during pregnancy. However, previous studies of SARS-CoV-2 in pregnancy have largely been limited to histopathologic studies of placentas and prenatal studies on the effects of different SARS-CoV-2 variants are scarce to date. To examine the effects of SARS-CoV-2 variants on the placenta and fetus, we investigated fetal and extra-fetal structures using prenatal MRI.
METHODS
For this prospective case-control study, two obstetric centers consecutively referred pregnant women for prenatal MRI after confirmed SARS-CoV-2 infection. Thirty-eight prenatal MRI examinations were included after confirmed infection with SARS-CoV-2 and matched 1:1 with 38 control cases with respect to sex, MRI field strength, and gestational age (average deviation 1.76 ± 1.65, median 1.5 days). Where available, the pathohistological examination and vaccination status of the placenta was included in the analysis. In prenatal MRI, the shape and thickness of the placenta, possible lobulation, and vascular lesions were quantified. Fetuses were scanned for organ or brain abnormalities.
FINDINGS
Of the 38 included cases after SARS-CoV-2 infection, 20/38 (52.6%) were infected with pre-Omicron variants and 18/38 (47.4%) with Omicron. Prenatal MRIs were performed on an average of 83 days (±42.9, median 80) days after the first positive PCR test. Both pre-Omicron ( = .008) and Omicron ( = .016) groups showed abnormalities in form of a globular placenta compared to control cases. In addition, placentas in the pre-Omicron group were significantly thickened (6.35, 95% CI .02-12.65, = .048), and showed significantly more frequent lobules ( = .046), and hemorrhages ( = .002). Fetal growth restriction (FGR) was observed in 25% (n = 5/20, = .017) in the pre-Omicron group.
INTERPRETATION
SARS-CoV-2 infections in pregnancy can lead to placental lesions based on vascular events, which can be well visualized on prenatal MRI. Pre-Omicron variants cause greater damage than Omicron sub-lineages in this regard.
FUNDING
Vienna Science and Technology Fund.
背景
已知孕妇感染新冠病毒（SARS-CoV-2）后胎儿会出现并发症。然而，此前关于孕妇感染SARS-CoV-2的研究主要局限于胎盘的组织病理学研究，且迄今为止，关于不同SARS-CoV-2变体影响的产前研究很少。为了研究SARS-CoV-2变体对胎盘和胎儿的影响，我们使用产前磁共振成像（MRI）对胎儿和胎儿外结构进行了研究。
方法
在这项前瞻性病例对照研究中，两个产科中心在确诊SARS-CoV-2感染后，连续将孕妇转诊进行产前MRI检查。确诊感染SARS-CoV-2后，纳入了38例产前MRI检查，并在性别、MRI场强和孕周方面与38例对照病例进行1:1匹配（平均偏差1.76±1.65，中位数1.5天）。如有可用信息，胎盘的病理组织学检查和疫苗接种状况也纳入分析。在产前MRI中，对胎盘的形状和厚度、可能的小叶形成和血管病变进行量化。对胎儿进行器官或脑部异常扫描。
研究结果
在38例纳入的SARS-CoV-2感染病例中，20/38（52.6%）感染了奥密克戎变异株之前的变体，18/38（47.4%）感染了奥密克戎变异株。在首次PCR检测呈阳性后，平均83天（±42.9，中位数80天）进行了产前MRI检查。与对照病例相比，奥密克戎变异株之前的变体组（P = 0.008）和奥密克戎变异株组（P = 0.016）均显示出胎盘呈球状的异常形态。此外，奥密克戎变异株之前的变体组胎盘明显增厚（6.35，95%置信区间0.02 - 12.65，P = 0.048），小叶形成（P = 0.046）和出血（P = 0.002）更为频繁。在奥密克戎变异株之前的变体组中，观察到25%（n = 5/20，P = 0.017）的胎儿生长受限（FGR）。
解读
孕期感染SARS-CoV-2可导致基于血管事件的胎盘病变，产前MRI能很好地显示这些病变。在这方面，奥密克戎变异株之前的变体比奥密克戎亚谱系造成的损害更大。
资金来源
维也纳科学技术基金。
Zotero 插件