CAJ | 학술논문

目的探讨胎儿颈项透明层(nuchal translucency,NT)厚度增加与妊娠结局的关系,以期用NT预测胎儿临床预后. 方法研究对象为2009年2月13日至2010年5月16日在昆明医科大学第一附属医院门诊就诊并行超声检查的妊娠早期单胎孕妇1839例.参照英国胎儿医学基金会的指南测量胎儿头臀径及胎儿NT厚度,随访妊娠结局.将预测不良妊娠结局发生高风险的界值分为NT≥2.0、2.5、3.0、3.5、4.5 mm,应用不同的界值,通过绘制受试者工作特征曲线评估NT增厚对不良妊娠结局的预测作用,观察NT增厚对临床结局的影响.用卡方检验或Fisher精确概率法分析敏感性和假阳性率之间的差异. 结果 1839例孕妇发生不良妊娠结局49例,不良妊娠结局发生率为2.7％.NT界值分别为2.0、2.5、3.0、3.5及4.5 mm时,预测总不良妊娠结局的阳性似然比分别为1.6、3.4、12.4、51.0及92.0,不同NT范围不良妊娠结局的发生率依次为2.7％、1.0％、4.0％、17.0％及75.0％.正常妊娠结局的比例随着NT增厚而降低.NT预测总不良妊娠结局的受试者工作特征曲线下面积为0.647,95％CI为0.561～0.732. 结论妊娠早期胎儿NT增厚与多种不良妊娠结局相关.不同界值下NT预测不良妊娠结局的发生率可为临床咨询提供客观依据,且NT预测不良妊娠结局的效力达中等水平.
목적 탐토태인경항투명층(nuchal translucency,NT)후도증가여임신결국적관계,이기용NT예측태인림상예후. 방법 연구대상위2009년2월13일지2010년5월16일재곤명의과대학제일부속의원문진취진병행초성검사적임신조기단태잉부1839례.삼조영국태인의학기금회적지남측량태인두둔경급태인NT후도,수방임신결국.장예측불량임신결국발생고풍험적계치분위NT≥2.0、2.5、3.0、3.5、4.5 mm,응용불동적계치,통과회제수시자공작특정곡선평고NT증후대불량임신결국적예측작용,관찰NT증후대림상결국적영향.용잡방검험혹Fisher정학개솔법분석민감성화가양성솔지간적차이. 결과 1839례잉부발생불량임신결국49례,불량임신결국발생솔위2.7％.NT계치분별위2.0、2.5、3.0、3.5급4.5 mm시,예측총불량임신결국적양성사연비분별위1.6、3.4、12.4、51.0급92.0,불동NT범위불량임신결국적발생솔의차위2.7％、1.0％、4.0％、17.0％급75.0％.정상임신결국적비례수착NT증후이강저.NT예측총불량임신결국적수시자공작특정곡선하면적위0.647,95％CI위0.561～0.732. 결론 임신조기태인NT증후여다충불량임신결국상관.불동계치하NT예측불량임신결국적발생솔가위림상자순제공객관의거,차NT예측불량임신결국적효력체중등수평.
Objective To discuss the relationship between pregnant outcomes and increased fetal nuchal translucency (NT),and to predict adverse outcomes of fetus with NT.Methods One thousand eight hundred and thirty-nine women who had their antenatal visits in the First Affiliated Hospital of Kunming Medical University from February 13,2009 to May 16,2010 were admitted into the study.Crown rump length (CRL) and NT of fetus were measured following the guideline of Fetal Medicine Foundation.Pregnant outcomes were followed-up.The cut-off points of high risk of adverse pregnant outcome were set as NT≥2.0 mm,2.5 mm,3.0 mm,3.5 mm or 4.5 mm.Receiver operating characteristics (ROC) curve was drawn at different cut-off points to estimate the value of NT to predict adverse pregnancy outcomes.Differences between sensitivity and false positive rate were analyzed by Chi-square test or Fisher's exact test.Results The adverse outcome rate in this population was 2.7％ (49/1839).The positive likelihood ratios of NT≥2.0 mm,2.5 mm,3.0 mm,3.5 mm and 4.5 mm for adverse outcomes were 1.6,3.4,12.4,51.0 and 92.0,respectively; and the incidences of adverse outcomes were 2.7％,1.0％,4.0％,17.0％ and 75.0％,which rose with the increase of NT.Area under ROC curve for adverse outcomes was 0.647 with 95％CI of 0.561-0.732.Conclusions NT increase is related to adverse pregnant outcomes.The predictive value of different NT for the incidence of adverse outcomes might provide evidence for clinical consultation.NT is applicable in predicting adverse outcomes.