早孕期胎儿颈项透明层厚度及颜面轮廓超声指标对21-三体综合征的诊断价值  

Diagnostic value of nuchal translucency thickness and facial profile ultrasonic markers for trisomy 21 syndrome in the first-trimester fetuses

作　　者：张广英[1] 曲素慧[1] 丁红宇[1] 刘蔚[1] 王莉[2] 

机构地区：[1]山东大学附属千佛山医院超声诊疗科,济南250014 [2]山东大学附属千佛山医院妇产科,济南250014

出　　处：《中华超声影像学杂志》2016年第11期957-961,共5页Chinese Journal of Ultrasonography

基　　金：山东省科技攻关项目（2012GSF11831）

摘　　要：目的回顾性分析颈项透明层（NT）厚度、额-上颌角（FMF角）、鼻前组织厚度与鼻骨长度的比值（PT／NBL）在早孕期正常胎儿及21-三体综合征胎儿间的差异，探讨其联合应用对早孕期21-三体综合征的诊断价值。方法回顾性分析经产科超声及染色体检查证实为21-三体综合征的35例胎儿的早孕期超声图像资料，测算其NT厚度、FMF角和PT／NBL，并与70例随机抽取的正常早孕期胎儿（孕期与病例组基本一致）进行对比分析；并对NT厚度、NT厚度联合FMF角、NT厚度联合FMF角和PT／NBL对21-三体综合征的检出率进行对比分析。结果①病例组NT厚度大于对照组，二者比较差异有显著统计学意义（t=7．401，P=0．00）；病例组20例（57．1％）NT增厚，对照组3例（4．3％）。②病例组FMF角大于对照组，二者比较差异有显著统计学意义（t=-5．283，P=0．00）；以对照组FMF角的单侧第95百分位（93．60）作为诊断参考值，病例组13例（37．1％）大于该值，对照组1例（1．4％）。③病例组PT／NBL大于对照组，二者比较差异有显著统计学意义（t=-7．826，P=0．00）；以对照组PT／NBL的单侧第95百分位（0．93）作为诊断参考值，病例组19例（54．3％）大于该值，对照组4例（5．7％）。④单独应用NT厚度、NT厚度＋FMF角联合应用、NT厚度＋FMF角＋PT／NBL联合应用诊断21-三体综合征的敏感度和约登指数均逐渐提升，三者间敏感度差异均具有统计学意义（P〈0．05），三者特异度均〉9（）％。结论早孕期21三体综合征胎儿的NT厚度、FMF角及PT／NBL三项参数均明显增大，以NT增厚最为常见，其次为PT／NBL增大，再次为FMF角增大。早孕期联合应用三大参数能明显提高21一三体综合征胎儿的检出率。Objective To retrospectively assess the diagnostic value of nuchal translucency （NT） thickness and facial profile ultrasonic markers Eincluding frontomaxillary facial （FMF） angle, and the ratio of prenasal thickness to nasal bone length （PT/NBL）] for trisomy 21 syndrome in first-trimester fetuses. Methods Ultrasonograhic images of 35 fetuses with trisomy 21 syndrome and 70 gestational age matched normal fetuses were analyzed in first-trimester. NT, FMF angle and the PT/NBL ratio were measured retrospectively in stored images from digital database between January 2012 and December 2015. The diagnostic value of NT, FMF angle and PT/NBL ratio were compared with different combinations. Results （1） The mean NT was significantly higher in the trisomy 21 group than that in controls （ t = 7. 401, P = 0.00）. The NT above 2.5mm was observed in 20 trisomy 21 fetuses （57.1%） and in 3 normal fetuses （4.3%）. （2） The mean FMF angle was significantly higher in the trisomy 21 group than that in controls （t = - 5.283, P = 0.00）. The FMF angle above the 95th percentile （93.6%） was observed in 13 trisomy 21 fetuses （37.1%） and in 1 normal fetus （1.4%）. （3） The mean PT/NBL ratio was significantly higher in the trisomy 21 group than that in controls （ t = - 7.826, P = 0.00）, The PT/NBL ratio above the 95th percentile （0.93） was observed in 19 trisomy 21 fetuses （54.3%） and in 4 normal fetuses （5.7%）. （4）The sensitivity and Youden index for trisomy 21 increased gradually, which were 57.1% and 0. 528 by using NT, and 74.3% and 0. 686 by using NT and FMF angle, and 91.4% and 0. 828 by using NT, FMF angle and PT/NBL ratio. There were significant differences in the detection rates of trisomy 21 among the three strategies, while the diagnostic specificity of the three strategies were more than 90%. Conclusions The three parameters are significantly increased in trisomy 21 fetus in first-trimester. First, increased NT was most commonly detected, followed by increased PT/

关 键 词：超声检查 产前 早孕期 21-三体综合征 颈项透明层厚度 颜面轮廓 

分 类 号：R714.5[医药卫生—妇产科学]