孕11~13^(+6)周胎儿心胸比例增大对不良妊娠结局的预测价值  

Value of increased fetal cardio thoracic ratio in predicting adverse pregnancy outcome in 11⁃13^(+6) weeks

作　　者：潘云祥[1] 王会敏[1] 安思微 刘艳芳[1] 何薇[2] 王丽敏[1] 尚宁[1] PAN Yun-xiang;WANG Hui-min;AN Si-wei;LIU Yan-fang;HE Wei;WANG Li-min;SHANG Ning(Department of Ultrasound,Guangdong Women and Children Hospital,Guangzhou 511400,China;Prenatal Diagnosis Center,Guangdong Women and Children Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院超声诊断科,广东广州511400 [2]广东省妇幼保健院医学遗传中心,广东广州511400

出　　处：《海南医学院学报》2021年第16期1240-1245,共6页Journal of Hainan Medical University

基　　金：广东省医学科研基金资助项目(A2018159)。

摘　　要：目的:探讨孕11~13+6周胎儿心胸比例增大对胎儿不良妊娠结局的预测价值。方法:回顾性分析孕11~13+6周心胸横径比(CTR)增大(CTR≥0.50)的86例胎儿的超声表现、染色体或基因检测结果,随访胎儿的妊娠结局。依据胎儿超声检查有无发现结构畸形分为:无结构畸形组(46例)、结构畸形组(40例),采用t检验比较两组间的CTR、颈后透明层厚度(NT)的差异,通过构建受试者工作曲线(ROC)计算曲线下面积(AUC),确定CTR、NT预测染色体异常的最佳诊断界值、敏感性、特异性。结果:86例胎儿均存在染色体或基因异常、遗传性疾病或结构畸形等严重问题。结构畸形组的CTR、NT明显大于无结构畸形组,差异有统计学意义(P<0.05)。60例胎儿经绒毛活检,检出巴氏水肿胎47例(78.3%,47/60)、染色体异常10例(16.7%,10/60),另外3例未发现异常。根据ROC曲线,CTR、NT预测染色体异常的曲线下面积分别是:0.691、0.954,诊断界值分别是:0.57、3.6 mm,敏感性分别为60.0%、100.0%,特异性分别约:79.6%、85.7%。随访显示,5例胎死宫内,其余81例均被引产,CTR增大预测不良妊娠结局的敏感性为100.0%。结论:孕11~13+6周胎儿CTR增大预示胎儿可能存在严重问题、临床预后不良,在早孕期应当重视CTR的准确评估,为胎儿妊娠结局的预测提供参考。Objective:To explore the value of increased fetal cardio thoracic ratio(CTR)in predicting fetal pregnancy out⁃come in 11⁃13+6 weeks.Methods:The ultrasonographic features,chromosome or gene detection and the pregnancy outcome of 86 fetuses with increased CTR in 11⁃13+6 weeks were retrospectively analyzed.They were divided into the non⁃structural malforma⁃tion group(46 cases)and the structural malformation group(40 cases)according to the fetal ultrasound examination.The differ⁃ences of CTR and nuchal translucency thickness(NT)between the two groups were compared by t test.The area under the curve(AUC)was calculated by constructing the receiver operating curve(ROC)to determine the best diagnostic threshold,sensitivity and specificity of CTR and NT in predicting chromosomal abnormalities.Results:All the 86 fetuses had serious problems such as chromosome or gene abnormalities,or structural malformations.The CTR and NT of the structural malformation group were sig⁃nificantly higher than those of the non⁃structural malformation group,and the difference was statistically significant(P<0.05).Through villous biopsy of 60 fetuses,47 cases(78.3%,47/60)with haemoglobin Bart’s disease,10 cases(16.7%,10/60)with chromosomal abnormalities were detected,and no abnormalities were detected in other 3 cases.According to the ROC curve,the AUC for CTR and NT to predict chromosomal abnormalities were 0.691 and 0.954,respectively,and the diagnostic cut⁃off val⁃ues were 0.57 and 3.6 mm,respectively.The sensitivity was 60.0%and 100.0%,the specificity was about 79.6%and 85.7%,re⁃spectively.Follow⁃up showed that 5 cases were death intrauterine,and the remaining 81 cases were induced to labor.The specifici⁃ty of CTR increase in predicting adverse pregnancy outcome was 100.0%.Conclusion:The increase of CTR in 11⁃13+6 weeks of gestation indicates that the fetus may have serious problems and poor clinical prognosis.Attention should be paid to the accurate evaluation of CTR in early pregnancy so as to provide referen

关 键 词：胎儿 早孕 心胸比 妊娠结局 

分 类 号：R714.5[医药卫生—妇产科学]