产前超声简化分级方法评估正常胎儿外侧裂的可行性研究  

Feasibility study of prenatal ultrasound in the evaluation of normal fetal sylvian fissure maturation by simplified grading

作　　者：廖伊梅 文华轩 汪兵[2] 向海山 曾晴 秦越 罗丹丹 梁美玲 温昕 丁妍 张梦雨 陈芷萱 袁鹰 李胜利 Liao Yimei;Wen Huaxuan;Wang Bing;Xiang Haishan;Zeng Qing;Qin Yue;Luo Dandan;Liang Meiling;Wen Xin;Ding Yan;Zhang Mengyu;Chen Zhixuan;Yuan Ying;Li Shengli(Department of Ultrasound,Shenzhen Maternity and Child Healthcare Hospital Affiliated to Nanfang Medical University,Shenzhen 518028,China;Department of Radiology,Peking University Shenzhen Hospital,Shenzhen 518035,China;Institute of Maternity and Child Medical Reasearch,Shenzhen Maternity and Child Healthcare Hospital Affiliated to Nanfang Medical University,Shenzhen 518028,China)

机构地区：[1]南方医科大学附属深圳妇幼保健院超声科,深圳518028 [2]北京大学深圳医院放射科,深圳518035 [3]南方医科大学附属深圳妇幼保健院妇幼医学研究所,深圳518028

出　　处：《中华超声影像学杂志》2022年第1期30-36,共7页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81771598)。

摘　　要：目的观察20~32周胎儿外侧裂在丘脑水平横切面上的超声形态学变化,简化正常胎儿外侧裂形态发育评估分级方法,并探讨其临床可行性。方法选取2018年9月至2020年6月于南方医科大学附属深圳妇幼保健院超声科进行常规超声检查的487例正常单胎孕妇。观察孕20~32周丘脑水平横切面上外侧裂形态学变化。根据脑岛形成和岛盖化过程的发育规律将外侧裂分为0~5级:直线(0级)、浅弧(1级)、钝角大平台(2级)、直角大平台(3级)、锐角大平台(4级)、工字形(5级)。记录检查孕周、妊娠结局。采用SPSS 20.0软件,用箱线图、Mann-Whitney U检验、Weighted Kappa系数等方法进行统计分析。结果280例胎儿获得左侧外侧裂分级,247例获得右侧外侧裂分级。20~32周胎儿外侧裂形态分级随妊娠进展从低向高发展:0级仅出现在20周的少数胎儿,20周后99.4%胎儿≥1级;1级出现在20~22周;2级20~25周;3级22~26周;4级25~32周;5级27~32周。箱线图及Mann-Whitney U检验均显示:双侧各级别外侧裂的孕周分布相同(P>0.05)。该分级方法在观察者间和观察者内具有较好的一致性,Weighted Kappa系数分别为0.857(95%CI=0.750~0.957)和0.939(95%CI=0.859~1.000)。结论简化的正常胎儿外侧裂发育评估分级方法可用于评估妊娠20~32周胎儿外侧裂发育成熟情况,且20~32周胎儿的双侧外侧裂发育分级基本对称。Objective To observe the morphological changes of the sylvian fissure on the transthalamic section of fetal brain at 20-32 weeks,and grade the fetal sylvian fissure development by means of a simple scoring system and explore its clinical feasibility.Methods From September 2018 to June 2020,487 normal single fetuses of 20-32 weeks were examined in Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University.The sylvian fissure maturation was analyzed on the transthalamic section of fetal brain at 20-32 weeks and was graded from 0 to 5:un-visualized(grade 0),shallow arc(grade 1),obtuse-angled platform(grade 2),right-angled platform(grade 3),acute-angled platform(grade 4),and closed operculum(grade 5).The pregnancy outcomes and gestational age were recorded.Statistical analysis was performed by SPSS 20.0 software using box plot,Mann-Whitney U test,Weighted Kappa coefficient.Results Left sylvian fissuer grades were obtained in 280 fetuses and right sylvian fissure grades were obtained in 247 fetuses.The fetal sylvian fissure maturation at 20-32 weeks was graded from 0 to 5,which increased with advancing gestation.Grade 0 only appeared in 3 fetuses at 20 weeks,and 99.4%fetuses at 20 weeks had grade≥1.Grade 1 appeared in 20-22 weeks,grade 2 in 20-25 weeks,grade 3 in 22-26 weeks,grade 4 in 25-32 weeks,and grade 5 in 27-32 weeks.Box-plot and Mann-Whitney U test showed that gestational week distribution of sylvian fissure at all grades was symmetric on both sides(P>0.05).The Weighted Kappa coefficients were 0.857(95%CI=0.750-0.957)and 0.939(95%CI=0.859-1.000),respectively,with strong consistency regarding inter-and intra-observer agreements.Conclusions Fetal sylvian fissure maturation at 20-32 weeks can be evaluated by means of a simple scoring system with symmetrical grading of both sides.

关 键 词：超声检查 胎儿 外侧裂 产前诊断 分级 

分 类 号：R714.53[医药卫生—妇产科学] R445.1[医药卫生—临床医学]