孕11～14周胎儿超声软指标在胎儿心脏结构评估中的价值
잉11～14주태인초성연지표재태인심장결구평고중적개치
Ultrasound soft markers and fetal cardiac structural assessment at 11-14 weeks
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2014年 3期 188-192 ,共5页

    杨艳东%张永良

    양염동%장영량

    妊娠初期%心脏缺损,先天性%颈部透明带检查 妊娠初期%心髒缺損,先天性%頸部透明帶檢查
    임신초기%심장결손,선천성%경부투명대검사
    Pregnancy trimester,first%Heart defects,congenital%Nuchal translucency measurement
    目的 探讨胎儿颈项透明层(NT)厚度、三尖瓣反流(TR)及静脉导管血流a波(DVa波)倒置等超声软指标在早孕期(孕11 ～14周)胎儿心脏结构评估中的价值.方法 2009年1月至2012年1月暨南大学附属第一医院胎儿医学科对孕11 ～14周4 673例胎儿进行超声检查,记录检查结果及妊娠结局,计算超声软指标在早孕期胎儿心脏结构检查中的假阳性率,以及对严重先天性心脏病(CHD)胎儿诊断的敏感度.结果 (1)CHD检查结果:4 673例胎儿中有31例产前超声诊断为CHD,其中17例在早孕期发现,5例在中孕期早期(15 ～ 16周)发现.31例产前超声诊断的CHD胎儿中有12例染色体异常(包括21三体5例、18三体2例、13 三体2例、Turner综合征2例、9号染色体倒位1例).(2)NT厚度与CHD产前诊断:4 673例胎儿中,NT厚度为第95～ 99百分位的胎儿206例(4.41％),有5例产前诊断为CHD,其中4例在孕早期诊断;NT厚度＜第95百分位的胎儿4 430例(94.80％),有16例产前诊断为CHD,其中5例在早孕期诊断;NT厚度＞第99百分位(即＞3.5 mm)的胎儿共37例(0.79％,37/4 673),有10例胎儿产前诊断为CHD,其中8例在早孕期诊断.(3)TR及DVa波倒置与CHD产前诊断:4 673例胎儿中TR 51例(1.09％),DVa波倒置98例(2.10％).31例产前诊断的CHD中,8例合并TR,7例合并DVa波倒置.(4)超声软指标对严重CHD检出的敏感度:31例产前诊断的CHD胎儿中,23例为严重CHD,早孕期任意一项超声软指标异常对检出严重CHD的敏感度为74％(17/23);NT厚度为第95 ～ 99百分位的诊断敏感度为22％(5/23),NT厚度＞第99百分位(即＞3.5 mm)者诊断敏感度为39％(9/23),TR的诊断敏感度为35％(8/23),DVa波倒置的诊断敏感度为30％ (7/23).(5)超声软指标对CHD检出的特异度:早孕期超声软指标检出CHD的特异度为:NT厚度为第95～99百分位时为4.30％ (201/4 673),NT厚度＞第99百分位时为0.58％(27/4 673),TR为0.92％ (43/4 673),DVa波倒置为1.94％ (91/4 673).结论 早孕期超声软指标中NT增厚、TR和DVa波倒置对胎儿心脏结构评估有很实用的临床价值,能检出大部分严重CHD,有利于产前更早期地作出CHD诊断.
    목적 탐토태인경항투명층(NT)후도、삼첨판반류(TR)급정맥도관혈류a파(DVa파)도치등초성연지표재조잉기(잉11 ～14주)태인심장결구평고중적개치.방법 2009년1월지2012년1월기남대학부속제일의원태인의학과대잉11 ～14주4 673례태인진행초성검사,기록검사결과급임신결국,계산초성연지표재조잉기태인심장결구검사중적가양성솔,이급대엄중선천성심장병(CHD)태인진단적민감도.결과 (1)CHD검사결과:4 673례태인중유31례산전초성진단위CHD,기중17례재조잉기발현,5례재중잉기조기(15 ～ 16주)발현.31례산전초성진단적CHD태인중유12례염색체이상(포괄21삼체5례、18삼체2례、13 삼체2례、Turner종합정2례、9호염색체도위1례).(2)NT후도여CHD산전진단:4 673례태인중,NT후도위제95～ 99백분위적태인206례(4.41％),유5례산전진단위CHD,기중4례재잉조기진단;NT후도＜제95백분위적태인4 430례(94.80％),유16례산전진단위CHD,기중5례재조잉기진단;NT후도＞제99백분위(즉＞3.5 mm)적태인공37례(0.79％,37/4 673),유10례태인산전진단위CHD,기중8례재조잉기진단.(3)TR급DVa파도치여CHD산전진단:4 673례태인중TR 51례(1.09％),DVa파도치98례(2.10％).31례산전진단적CHD중,8례합병TR,7례합병DVa파도치.(4)초성연지표대엄중CHD검출적민감도:31례산전진단적CHD태인중,23례위엄중CHD,조잉기임의일항초성연지표이상대검출엄중CHD적민감도위74％(17/23);NT후도위제95 ～ 99백분위적진단민감도위22％(5/23),NT후도＞제99백분위(즉＞3.5 mm)자진단민감도위39％(9/23),TR적진단민감도위35％(8/23),DVa파도치적진단민감도위30％ (7/23).(5)초성연지표대CHD검출적특이도:조잉기초성연지표검출CHD적특이도위:NT후도위제95～99백분위시위4.30％ (201/4 673),NT후도＞제99백분위시위0.58％(27/4 673),TR위0.92％ (43/4 673),DVa파도치위1.94％ (91/4 673).결론 조잉기초성연지표중NT증후、TR화DVa파도치대태인심장결구평고유흔실용적림상개치,능검출대부분엄중CHD,유리우산전경조기지작출CHD진단.
    Objective To evaluate the detection rate of congenital heart defect (CHD) during the first trimester screening for chromosomal abnormalities,the role of ultrasound soft markers including increased nuchal translucency (NT),tricuspid regurgitation (TR) and abnormal ductus venosus (DV) flow in the screening for cardiac anomalies was also investigated.Methods From January 2009 to January 2012,4 673 fetuses were scanned at 11-14 weeks at Department of Fetal Medicine,the First Affiliated Hospital of Jinan University.The ultrasound findings and follow up outcomes were recorded,False-positive rate of different first-trimester ultrasound markers for the detection of CHD was calculated,sensitivity of the markers for all major CHD was calculated as well.Results There was a significant association between major CHD and first trimester ultrasound markers.(1) Overall findings:among the 4 673 fetuses,31 fetuses were diagnosed CHD prenatally,17,12 and 2 of which were detected in the first,second and third trimester,respectively.In 22 of the 31 CHD cases,invasive procedure was performed,fetal karyotype was abnormal in 12 cases,including triosmy 21 (5 cases),trisomy 18 (2 cases),trisomy 13 (2 cases),Turner syndrome (2 cases) and pericentric inversion of chromosome 9 (1 cases).(2) NT measurement and prenatal detected CHD:in 4 673 cases,NT measurement between 95th-99th percentile were present in 206 (4.41％),5 cases were diagnosed CHD prenatally,in 4 of 5 cases were detected in first trimester; NT measurement ＜ 95th percentile were present in 4 430(94.80％),16 cases were diagnosed CHD prenatally,in 5 of 16 cases were detected in first trimester; NT measurement ＞ 99th percentile (＞ 3.5 mm) were present in 37 (0.79％,37/4 673),10 cases were diagnosed CHD prenatally,in 8 of 10 cases were detected in first trimester.(3) TR and inverted a-wave at the DV and prenatal detected CHD:among 4 673 cases,TR or inverted a-wave at the DV were present in 51 (1.09％),98 (2.10％) respectively.TR was present in 8 of 31 CHD cases,inverted a-wave at the DV was present in 7 of 31 CHD cases.(4)Sensitivity of different first trimester ultrasound markers for detection of major CHD cases:in 31 CHD cases diagnosed prenatally,23 eased were defined as major CHD.Sensitivity of at least one of the ultrasound narkers,NT measurement between 95th-99th percentile,＞ 99th percentile(＞ 3.5 mm),TR or inverted a-wave at the DV for detection of major CHD eases was 74％ (17/23),22％ (5/23),39％ (9/23),35％ (8/23),30％ (7/23),respectively.(5) Specificity of different first trimester ultrasound markers for detection of CHD cases:specificity of NT measurement between 95th-99th percentile,＞ 99th percentile(＞ 3.5 mm),TR or inverted a-wave at the DV for detection of major CHD cases was 4.30％ (201/4 673),0.58％ (27/4 673),0.92％ (43/4 673),1.94％ (91/4 673).Conclusions Routine first trimester soft markers for chromosomal abnormalities screening combined with cardiac assessment can detect quite a number of major heart defects.Increased NT,TR and abnormal DV flow can be important indicators for echocardiography,which is favorable to early prenatal diagnosis of CHD.
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