胎儿心脏横径Z-评分预测重型α-地中海贫血的价值  

Value of fetal heart diameter Z-score in prediction of homozygous α-thalassemia-1at mid-pregnancy

作　　者：黎新艳[1] 黄欢[1] 李雪芹[1] 丘小霞[1] 田晓先[1] 

机构地区：[1]广西壮族自治区妇幼保健院超声科,南宁530103

出　　处：《中华超声影像学杂志》2017年第10期850-854,共5页Chinese Journal of Ultrasonography

基　　金：广西医疗卫生重点科研课题（重2010063）;广西医药卫生科学研究基金（桂卫科Z2011087）;广西医疗卫生适宜技术开发与推广应用项目（S2017062）;广西妇幼健康服务重点学科（桂卫妇幼发[2017]2号）

摘　　要：目的探讨胎儿心脏横径（HD）Z-评分在预测重型α-地中海贫血中的价值。方法选取广西壮族自治区妇幼保健院产前检查具有胎儿重型α-地中海贫血风险的中孕期单胎高危孕妇214例，15-22孕周。行二维超声心动图检查测量胎儿心脏HD并换算成乙评分。用R0c曲线分析心脏HDZ-评分预测胎儿重型α-地中海贫血的效能并与心胸比（CTR）预测效能作比较。结果①纳人本研究的胎儿中患病组57例，非患病组157。②与非患病组比较，患病组胎儿心脏HD及Z-评分明显增高，差异有统计学意义（P〈0．001）。③以HDZ-评分〉2．76分为截断值，其在15～22孕周预测重型α-地中海贫血的敏感性为92．98％，特异性为100％；以CTR〉0．52为截断值，其在15～22孕周预测重型α-地中海贫血的敏感性为87．72％，特异性为91．72％。两者ROC曲线下面积（AUC）比较，差异有统计学意义（Z=2．286，P〈0．05）。结论胎儿心脏HDZ-评分是中孕期无创、高效预测重型α-地中海贫血的新指标，其预测效能高于传统CTR，可以提高重型”地中海贫血胎儿的产前检出率，减少不必要的侵人性操作。Objective To evaluate the efficacy of fetal heart diameter（HD） Z-score as predictors of homozygous α-thalassemia-1. Methods Two hundred and fourteen cases of Single mid-pregnancies（15 - 22 W） at risk of homozygous α-thalassemia-1 were enrolled. Fetal HD were first measured. Next, the Z-scores of HD were calculated separately based on previously constructed Z-score models. Finally, the accuracy of this variable was analyzed and compared with that from the cardiothoracic ratio （CTR） by ROC curves analysis. Results ①A total of 214 singleton pregnancies were recruited in which 57 cases were homozygous α-thalassemia-1 fetuses and the other 157 cases were unaffected. ②The affected fetal HD and Z-score were significantly higher than those in the unaffected fetuses（ P （0.01）. ③With the HD Z-score 〉2.76 as the best cutoff value, the sensitivity and specificity of predicting homozygous α-thalassemia-1 fetuses in 15 - 22 gestational week were 92.98 % and 100 % ; If a best cut-off value of CTR 〉0.52 was used for prediction, the sensitivity was 87.72% and the specificity was 91.72%. Compared with CTR, the discriminative power of HD Z-score was better （ Z value = 2. 286, P 〈0.01）. Conclusions HD Z-score is a novel, effective and noninvasive predictor of homozygous α-thalassemia-1 in mid-pregnancy. Its prediction efficiency is higher than that of traditional CTR. It can improve the prenatal detection rate of homozygous α-thalassemia-1 fetus, reduce unnecessary invasive operation and save expenses.

关 键 词：超声心动描记术 重型α-地中海贫血 心脏横径 Z-评分 心胸比 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]