超声检测NT增厚与静脉导管频谱异常在胎儿复杂心脏畸形筛查中的价值
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摘要
目的探讨孕早期超声检测颈部透明层(nuchal translucency, NT)增厚与静脉导管(DV)频谱异常在筛查胎儿复杂先天性心脏畸形中的价值。方法选择2015年9月～2017年9月在我院建档做产前检查并且随访到妊娠结局的5180例孕妇为观察对象,所有孕妇11～13~(+6)周进行NT厚度与静脉导管多普勒血流频谱检测。对于NT增厚和DV异常的胎儿,通过经阴道(15～16周)或经腹(20～24周)途径行胎儿超声心动图检查。检查结果与尸检结果和新生儿随访结果相对照。结果与NT正常的胎儿相比,NT增厚胎儿更容易患复杂先天性心脏畸形(P<0.05),灵敏度81.25%,特异度95.17%,阳性预测值13.59%,阴性预测值99.82%,准确率95.04%;DV异常胎儿与DV正常胎儿相比,复杂先天性心脏畸形的发生率明显高(P<0.05),灵敏度85.42%,特异度95.58%,阳性预测值15.30%,阴性预测值99.86%,准确率95.48%;NT且DV异常胎儿与NT或DV正常胎儿相比,复杂先天性心脏畸形的发生率显著高(P<0.05),灵敏度68.75%,特异度98.46%,阳性预测值29.46%,阴性预测值99.7%,准确率98.19%。结论孕早期超声检测NT增厚与静脉导管频谱异常在筛查胎儿复杂先天性心脏畸形中具有重要的价值。
Objective To investigate the value of detecting NT thickening and DV spectrum abnormality in early pregnancy in screening fetal complex cardiac malformations. Methods From September 2015 to September 2017, 5180 pregnant women, who had been performed prenatal examination in our hospital from September 2015 to September 2017 and were followed up to pregnancy outcome, were selected as study subjects. NT thickness and Doppler blood flow spectrum of venous ducts were measured in all pregnant women at 11136 weeks. Fetal echocardiography was performed by transvaginal(1516 weeks) or transabdominal(20～24 weeks) approach for fetuses with NT thickening and abnormal DV. The results were compared with those of autopsy and neonatal follow-up. Results Compared with NT normal fetus, NT thickened fetus was more susceptible to complex congenital heart defects(P<0.05), with sensitivity of 81.25%, specificity of 95.17%, positive predictive value of 13.59%, negative predictive value of 99.82%, accuracy 95.04%; Compared with the normal fetus, the incidence of complex congenital heart malformation was significantly higher(P<0.05), the sensitivity was 85.42%, the specificity was 95.58%, the positive predictive value was 15.30%, the negative predictive value was 99.86%, and the accuracy rate was 95.48%; by NT and DV abnormal fetus compared with NT or DV normal fetus, the incidence of complex congenital heart malformation was significantly higher(P<0.05), the sensitivity was 68.75, the specificity was 98.46, the positive predictive value was 29.46, the negative predictive value was 99.7 and the accuracy was 98.19. Conclusion The detection of NT thickening and venous catheter spectrum abnormality in early pregnancy has important value in screening fetal complex congenital heart malformation.
Objective To investigate the value of detecting NT thickening and DV spectrum abnormality in early pregnancy in screening fetal complex cardiac malformations. Methods From September 2015 to September 2017, 5180 pregnant women, who had been performed prenatal examination in our hospital from September 2015 to September 2017 and were followed up to pregnancy outcome, were selected as study subjects. NT thickness and Doppler blood flow spectrum of venous ducts were measured in all pregnant women at 11136 weeks. Fetal echocardiography was performed by transvaginal(1516 weeks) or transabdominal(20～24 weeks) approach for fetuses with NT thickening and abnormal DV. The results were compared with those of autopsy and neonatal follow-up. Results Compared with NT normal fetus, NT thickened fetus was more susceptible to complex congenital heart defects(P<0.05), with sensitivity of 81.25%, specificity of 95.17%, positive predictive value of 13.59%, negative predictive value of 99.82%, accuracy 95.04%; Compared with the normal fetus, the incidence of complex congenital heart malformation was significantly higher(P<0.05), the sensitivity was 85.42%, the specificity was 95.58%, the positive predictive value was 15.30%, the negative predictive value was 99.86%, and the accuracy rate was 95.48%; by NT and DV abnormal fetus compared with NT or DV normal fetus, the incidence of complex congenital heart malformation was significantly higher(P<0.05), the sensitivity was 68.75, the specificity was 98.46, the positive predictive value was 29.46, the negative predictive value was 99.7 and the accuracy was 98.19. Conclusion The detection of NT thickening and venous catheter spectrum abnormality in early pregnancy has important value in screening fetal complex congenital heart malformation.
引文
[1] 裴秋艳,张晓红,李建国,等.胎儿颈项透明层增厚及静脉导管血流频谱异常在先天性心脏畸形筛查中的价值[J]. 中国超声医学杂志, 2011,27(2):169-171.
[2] 刘冬梅,杨敏,顾晓宁,等.静脉导管频谱在胎儿先天性心脏畸形中的价值[J]. 哈尔滨医科大学学报, 2016,50(4):342-346.
[3] 严英榴. 产前超声诊断学[M]. 北京:人民卫生出版社,2003.445.
[4] 谢秀芳,李丽娟,李银华,等.彩色多普勒超声综合检测晚孕胎儿动静脉血流改变在围产儿不良结局中的价值[J].广东医学,2009,30(7):1068-1070.
[5] 任静,陈爱军,李扬,等.NT值异常与TORCH宫内感染、胎儿染色体异常、结构异常的相关性分析[J].中国妇幼保健, 2017,32(6):1238-1241.
[6] Jouannic JM, Thieulin AC, Bonnet D, et al. Measurement of nuchai translucency for prenatai screening of congenital heart defects:a population based evaluation [J]. Prenat Diagn, 2011, 31(13): 1264-1273.
[7] 刘桂军. 孕早期超声检测静脉导管血流频谱及颈项透明层厚度在胎儿心脏畸形诊断中的价值 [J]. 中国妇幼保健,2017,32(15):3680-3681.
[8] 孟小军,肖鸽飞,谢文杰,等.胎儿静脉导管及颈项透明层厚度的超声检测在先天性心脏畸形筛查中的价值[J]. 临床超声医学杂志,2012.14(3):174-179.
[9] Borrell A, Grande M, Bennasar M, et al. First-trimester detection of major cardiac effects with the use of ductus venosus blood flow [J]. Ultrasound Obstet Gynecol, 2013, 421(1): 51-57.
[10] 李胜利.胎儿畸形产前超声诊断学[M].北京:人民卫生出版社,2004.605.
[11] 陈海燕.胎儿静脉导管彩色多普勒超声在产前监测中的应用进展[J].医学信息,2013,26(2):563-564.
[12] 查文,徐倩君,吕康泰.早期静脉导管多普勒超声检测筛查胎儿异常[J].中国妇幼保健,2011,26(19):3010-3011.
[13] 孟华,姜玉新,戚庆玮,等.早孕期胎儿静脉导管频谱波型分析[J]. 中国医学影像技术,2007,23(8):1208-1209.
[14] 谢维维,解左平,邱合荣.中孕早期观察胎儿静脉导管血流频谱a谷形态筛查胎儿心脏畸形的意义 [J]. 中国优生与遗传杂志, 2017,25(4):107-112.
[15] 赵蕊,王小燕.彩色多普勒超声在胎儿先天性心脏病筛查中的临床价值分析[J]. 医学影像学杂志, 2016,26(5):934-936.
[16] 李霞,马向军.彩色多普勒超声诊断胎儿心脏畸形的临床价值分析[J]. 医学影像学杂志, 2018,28(2):331-333.
[2] 刘冬梅,杨敏,顾晓宁,等.静脉导管频谱在胎儿先天性心脏畸形中的价值[J]. 哈尔滨医科大学学报, 2016,50(4):342-346.
[3] 严英榴. 产前超声诊断学[M]. 北京:人民卫生出版社,2003.445.
[4] 谢秀芳,李丽娟,李银华,等.彩色多普勒超声综合检测晚孕胎儿动静脉血流改变在围产儿不良结局中的价值[J].广东医学,2009,30(7):1068-1070.
[5] 任静,陈爱军,李扬,等.NT值异常与TORCH宫内感染、胎儿染色体异常、结构异常的相关性分析[J].中国妇幼保健, 2017,32(6):1238-1241.
[6] Jouannic JM, Thieulin AC, Bonnet D, et al. Measurement of nuchai translucency for prenatai screening of congenital heart defects:a population based evaluation [J]. Prenat Diagn, 2011, 31(13): 1264-1273.
[7] 刘桂军. 孕早期超声检测静脉导管血流频谱及颈项透明层厚度在胎儿心脏畸形诊断中的价值 [J]. 中国妇幼保健,2017,32(15):3680-3681.
[8] 孟小军,肖鸽飞,谢文杰,等.胎儿静脉导管及颈项透明层厚度的超声检测在先天性心脏畸形筛查中的价值[J]. 临床超声医学杂志,2012.14(3):174-179.
[9] Borrell A, Grande M, Bennasar M, et al. First-trimester detection of major cardiac effects with the use of ductus venosus blood flow [J]. Ultrasound Obstet Gynecol, 2013, 421(1): 51-57.
[10] 李胜利.胎儿畸形产前超声诊断学[M].北京:人民卫生出版社,2004.605.
[11] 陈海燕.胎儿静脉导管彩色多普勒超声在产前监测中的应用进展[J].医学信息,2013,26(2):563-564.
[12] 查文,徐倩君,吕康泰.早期静脉导管多普勒超声检测筛查胎儿异常[J].中国妇幼保健,2011,26(19):3010-3011.
[13] 孟华,姜玉新,戚庆玮,等.早孕期胎儿静脉导管频谱波型分析[J]. 中国医学影像技术,2007,23(8):1208-1209.
[14] 谢维维,解左平,邱合荣.中孕早期观察胎儿静脉导管血流频谱a谷形态筛查胎儿心脏畸形的意义 [J]. 中国优生与遗传杂志, 2017,25(4):107-112.
[15] 赵蕊,王小燕.彩色多普勒超声在胎儿先天性心脏病筛查中的临床价值分析[J]. 医学影像学杂志, 2016,26(5):934-936.
[16] 李霞,马向军.彩色多普勒超声诊断胎儿心脏畸形的临床价值分析[J]. 医学影像学杂志, 2018,28(2):331-333.