产前超声监测胎儿心胸比例在重型α-地中海贫血中的应用研究  

Application of prenatal ultrasound monitoring in fetal cardiothoracic ratio in severeαthalassemia

作　　者：张映霞 钟万霖 张淑惠 ZHANG Ying-xia;ZHONG Wan-lin;ZHANG Shu-hui(Pregnancy Inspec-tion Center,Meizhou Maternal and Child Health and Family Planning Service Center,Meizhou 514000,Guangdong,China)

机构地区：[1]梅州市妇幼保健计划生育服务中心孕检中心,广东梅州514000

出　　处：《中国校医》2021年第11期876-878,共3页Chinese Journal of School Doctor

摘　　要：目的研究产前超声监测胎儿心胸比例在重型α-地中海贫血中的应用。方法回顾性分析2017年1月—2019年12月在本院行产前诊断确诊的42例重型α-地中海贫血胎儿及125例非重型a地贫胎儿的超声影像学结果。所有孕妇均定期接受产前超声检测胎儿心胸比例监测。观察胎儿心脏横径(HL)、胸腔横径(TL),并计算心胸比值(CR)。对比两组超声结果得出结论。结果12~17周、18~22周、23~25周时,重型组HL值为(15.43±1.83)mm、(22.46±1.92)mm、(28.71±4.34)mm,均高于非重型的(11.64±1.37)mm、(17.31±1.85)mm、(26.42±2.13)mm(P值均<0.05);12~17周、18~22周、23~25周时,重型组TL值为(18.42±1.73)mm、(28.42±2.31)mm、(45.34±4.76)mm,均低于非重型组的(23.72±2.13)mm(31.46±2.85)mm、(50.42±5.38)mm(P值均<0.05);12~17周、18~22周、23~25周时,重型组CR值为(0.55±0.03)mm、(0.59±0.06)mm、(0.65±0.07)mm,均高于非重型组的(0.46±0.05)mm、(0.53±0.04)mm、(0.57±0.03)mm(P值均<0.05)。两组HL、TL、CR值均大于12~17周,且23~25周时两组HL、TL、CR值均大于18~22周(P值均<0.05);ROC曲线显示,18~22周的CR值对重型α-地中海贫血胎儿的诊断预测效能最佳,其反应性曲线形面积为0.962(95%CI:0.931~0.965),最佳阈值为0.465 mm,灵敏度为95.20%,特异度为85.30%,约登指数为0.805。结论产前超声监测胎儿心胸比例应用于重型α-地中海贫血胎儿的监测中具有较高的价值,且该方法更为安全、准确,值得临床推广应用。Objective To study the application of prenatal ultrasound monitoring in fetal cardiothoracic ratio in severeαthalassemia.Methods The ultrasound imaging results of 42 severeαthalassemia fetuses and 125 nonsevereαthalassemia fetuses diagnosed in our hospital from January 2017 to December 2019 were retrospectively analyzed.All the pregnant women were regularly monitored for the fetal cardiothoracic ratio by prenatal ultrasound.The fetal heart diameter(HL)and chest diameter(TL)were observed,and the cardiothoracic ratio was calculated(CR).The results of the two groups were compared.Results During 12-17 weeks,18-22 weeks and 23-25 weeks,the HL values of the severe group were(15.43±1.83)mm,(22.46±1.92)mm and(28.71±4.34)mm respectively,which were higher than those of the non-severe group:(11.64±1.37)mm,(17.31±1.85)mm and(26.42±2.13)mm respectively(all P<0.05);during 12-17 weeks,18-22 weeks and 23-25 weeks,the TL values of the severe group were(18.42±1.73)mm,(28.42±2.31)mm and(45.34±4.76)mm respectively,which were lower than those of the nonsevere group:(23.72±2.13)mm(31.46±2.85)mm and(50.42±5.38)mm respectively(all P<0.05);during 12-17 weeks,18-22 weeks and 23-25 weeks,the CR values of the severe group were(0.55±0.03)mm,(0.59±0.06)mm and (0.65±0.07)mm respectively,which were higher than those of the nonsevere group:(0.46±0.05)mm,(0.53±0.04)mm and (0.57±0.03)mm respectively(P<0.05).During 23-25 weeks,the values of HL,TL and CR in the two groups were greater than those during 12-17 weeks,and 18-22 weeks(P<0.05).The ROC curve showed that during 18-22 weeks the CR value had the best predictive efficacy for the diagnosis of severeαthalassemia fetuses,and its response curve area was 0.962(95%CI:0.931-0.965),the best threshold was 0.465 mm,the sensitivity was 95.20%,the specificity was 85.30%,and the Yoden index was 0.805.Conclusion The prenatal ultrasound monitoring of fetal cardiothoracic ratio in severeαthalassemia fetal monitoring has a high value,and the method is safe and accurate.So it is worthy of

关 键 词：Α-地中海贫血 产前诊断 超声检查 心胸比例 

分 类 号：R715.5[医药卫生—妇产科学]