胎儿心脏干预与期待管理在先天性心脏病中的比较：一项系统综述与荟萃分析。
完整摘要 · 中文译文
目的：评估胎儿心脏介入（FCI）与预期管理相比，在双心室循环（BVC）、活产率和出生后死亡率方面的结局，并根据FAV的技术成功情况检验结局。 方法：本系统评价和荟萃分析遵循系统评价和荟萃分析首选报告项目（PRISMA）指南。检索了PubMed、Embase、Web of Science和Cochrane Library，检索时间从建库至2025年12月31日，纳入观察性FCI研究。主要分析仅限于具有内部预期管理对照的研究；不符合条件的非比较性FAV研究仅考虑用于次要的技术成功分析。在Stata中进行了随机效应荟萃分析，并使用I²评估异质性。 结果：主要FCI与预期管理综合比较中纳入了11项比较性报告，代表11个独立研究人群，共包括775例胎儿（418例干预，357例对照）。总体FCI估计值同时包含技术成功和失败的手术。在具有可获取活产数据的队列中，FCI组271/315例（86.0%）活产，对照组287/319例（90.0%）活产，两组间无显著差异（OR 0.680，95% CI 0.350-1.320；p = 0.256）。在具有可获取出生后结局数据的活产婴儿中，FCI组53/271例（19.6%）发生出生后死亡，预期管理组94/287例（32.8%），FCI后出生后死亡率较低（OR 0.457 , 95% CI 0.280-0.746; p = 0.002）。对于FAV，活产婴儿中的出生后死亡较低（OR 0.419, 95% CI 0.216-0.813; p = 0.010），而BVC显示出非显著趋势（OR 2.260, 95% CI 0.970-5.290; p = 0.060）。胎儿肺动脉瓣成形术（FPV）与BVC（OR 2.430, 95% CI 0.880-6.760; p = 0.088）或活产婴儿中的出生后死亡（OR 0.432, 95% CI 0.098-1.909; p = 0.268）无显著关联。技术成功的FAV与不成功的FAV相比，与更高的BVC和活产几率相关。胎儿房间隔干预（FASI）分析仅包括活产和活产婴儿中的出生后死亡。活产（OR 0.480, 95% CI 0.110-2.060; p = 0.325）或活产婴儿中的出生后死亡（OR 0.433, 95% CI 0.127-1.482; p = 0.183）未发现统计学显著差异。 结论：FAV与活产婴儿中较低的出生后死亡几率相关，并显示出改善BVC的非显著趋势，而技术成功的FAV与不成功的FAV相比，与更高的BVC和活产几率相关。相比之下，FPV和FASI的比较证据仍然稀少，这些发现应被视为探索性的。
完整摘要 · 英文原文
OBJECTIVES: To evaluate biventricular circulation (BVC), live birth, and postnatal mortality after fetal cardiac intervention (FCI) compared with expectant management, and to examine outcomes according to technical success of FAV. METHODS: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, Web of Science, and Cochrane Library were searched from database inception through 31 December 2025 for observational FCI studiehis systematic review and meta-analysis followed PRISs. The primary analysis was limited to studies with an internal expectant-management comparator; eligible non-comparative FAV studies were considered only for the secondary technical-success analysis. Random-effects meta-analyses were performed in Stata, and heterogeneity was assessed using I². RESULTS: Eleven comparative reports representing 11 independent study populations were included in the primary FCI-versus-expectant-management synthesis, comprising 775 fetuses (418 interventions and 357 controls). Overall FCI estimates included both technically successful and unsuccessful procedures. Among cohorts with available live-birth data, live birth occurred in 271/315 (86.0%) FCI cases and 287/319 (90.0%) controls, with no significant difference between groups (OR 0.680, 95% CI 0.350-1.320; p = 0.256). Postnatal death among live-born infants with available postnatal outcome data occurred in 53/271 (19.6%) in the FCI group and 94/287 (32.8%) in the expectant-management group and was lower after FCI (OR 0.457, 95% CI 0.280-0.746; p = 0.002). For FAV, postnatal death among live-born infants was lower (OR 0.419, 95% CI 0.216-0.813; p = 0.010), whereas BVC showed a non-significant trend (OR 2.260, 95% CI 0.970-5.290; p = 0.060). Fetal pulmonary valvuloplasty (FPV) showed no significant association with BVC (OR 2.430, 95% CI 0.880-6.760; p = 0.088) or postnatal death among live-born infants (OR 0.432, 95% CI 0.098-1.909; p = 0.268). Technically successful FAV was associated with higher odds of BVC and live birth compared with unsuccessful FAV. Fetal atrial septal intervention (FASI) analyses included live birth and postnatal death among live-born infants only. No statistically significant difference was found for live birth (OR 0.480, 95% CI 0.110-2.060; p = 0.325) or postnatal death among live-born infants (OR 0.433, 95% CI 0.127-1.482; p = 0.183). CONCLUSIONS: FAV was associated with lower odds of postnatal death among live-born infants and showed a non-significant trend toward improved BVC, while technically successful FAV was associated with higher odds of BVC and live birth than unsuccessful FAV. In contrast, comparative evidence for FPV and FASI remains sparse, and these findings should be interpreted as exploratory.