产前超声联合羊水AFP、GGTP水平检测对胎儿先天性食管闭锁的诊断价值  

Clinical value of prenatal ultrasound combined with AFP and GGTP in amniotic fluid in the diagnosis of congenital esophageal atresia in fetuses

作　　者：石晓东 段仰灿[1] 李聪 张忠路[1] 徐焕萍 寻凤华 Shi Xiaodong;Duan Yangcan;Li Cong;Zhang Zhonglu;Xu Huanping;Xun Fenghua(Department of Ultrasound,the Affiliated Hospital of Jining Medical College,Jining 272000,China)

机构地区：[1]济宁医学院附属医院超声科,济宁272000

出　　处：《中华解剖与临床杂志》2024年第7期486-491,共6页Chinese Journal of Anatomy and Clinics

基　　金：山东省中医药科技发展计划(2019-0478);济宁市重点研发计划(2019SMNS004)。

摘　　要：目的探讨产前超声联合羊水甲胎蛋白(AFP)、γ-谷氨酰转移酶(GGTP)水平检测在胎儿先天性食管闭锁(EA)诊断中的临床价值。方法病例对照研究。纳入2014年3月—2023年6月济宁医学院附属医院132例孕妇,孕妇年龄21~42岁,孕周21~40周。132例孕妇于孕16~22周时超声检查疑似EA,孕19~26周进一步行羊水检查。根据胎儿或新生儿临床结局分为2组,经分娩后尸检、外科手术和/或影像学检查确诊为EA的82例为EA组,排除EA的50例为非EA组。观察指标:(1)比较2组孕妇年龄、孕次、产次、超声检查孕周、羊水检测孕周等临床基线资料。(2)观察2组孕妇产前超声检查胎儿食管、胃肠征象,比较胎儿脐动脉血流峰谷比(S/D)、羊水指数(AFI)、羊水暗区最大深度(AFD)、吞咽指数等超声指标。(3)比较2组孕妇产前羊水检查AFP、GGTP水平。(4)采用受试者操作特征(ROC)曲线分析产前超声联合羊水AFP、GGTP水平检测诊断胎儿EA的临床价值。结果(1)2组孕妇年龄、孕次、产次、超声检查孕周、羊水检测孕周等临床基线资料比较,差异均无统计学意义(P值均>0.05)。(2)EA组82例,临床分型Ⅰ型13例,Ⅲ型69例。产前超声检查显示:Ⅰ型无食管气管瘘(TEF),胃不充盈,远近端食管呈盲端;Ⅲ型伴远端TEF,胃可充盈良好,远端、近端食管可见液性回声,胃肠道内也可见内容物充盈。82例中,囊袋状征象58例,胃泡小23例,胃泡不显示40例,羊水过多62例。非EA组50例产前超声检查显示:胎儿食管呈管状肌性结构,管壁可显示强-低-强3层回声;胃泡小41例,不显示9例。EA组的AFD、AFI、S/D分别为(7.92±1.05)cm、(23.17±4.14)cm、3.45±0.56,高于非EA组的(7.48±0.96)cm、(15.62±2.38)cm、3.12±0.47;EA组的吞咽指数为(8.11±2.14)mL/h,低于非EA组的(16.35±3.29)mL/h:差异均有统计学意义(t=2.41、11.75、3.48、17.44,P值均<0.05)。(3)EA组的羊水AFP、GGTP水平分别为(6037.42±973.65)ng/mL、(238.15±64.ObjectiveThis study aimed to explore the clinical value of prenatal ultrasound combined with alpha-fetoprotein(AFP)andγ-glutamyltransferase(GGTP)in amniotic fluid in the diagnosis of congenital esophageal atresia(EA)in fetuses.MethodsIn the case-control study,132 pregnant women(age,21-42 years;gestational age,21-40 weeks)in the Affiliated Hospital of Jining Medical College were enrolled between March 2014 and June 2023.The pregnant women with suspected EA were examined by ultrasound after 16-22 weeks of gestational age,and amniotic fluid examination was conducted after 19-26 weeks of gestational age.Based on the clinical outcomes of fetuses or neonates,the pregnant women were divided into two groups.Based on autopsy,postnatal surgery and imaging examination showed 82 cases with EA in the EA group and 50 cases without EA in the non-EA group.The observation indexes were as follows:(1)The clinical baseline data were compared between the two groups,including age,gravidity,parity,gestational age by ultrasound,and amniotic fluid.(2)The fetal esophageal and gastrointestinal signs by prenatal ultrasound in both groups were observed,and the ratio of maximum systolic blood flow velocity to end-diastolic blood flow velocity of fetal umbilical artery(S/D),amniotic fluid index(AFI),differences of amniotic fluid depth(AFD),and swallowing index were compared.(3)The levels of AFP and GGTP by prenatal amniotic fluid examination were compared between the two groups.(4)The clinical diagnostic value of prenatal ultrasound combined with AFP and GGTP in amniotic fluid for fetal EA was analyzed by using receiver operating characteristic(ROC)curves.ResultsNo significant difference in clinical baseline data(age,gravidity,parity,gestational age by ultrasound,and amniotic fluid examination)was found between the two groups(all P values>0.05).A total of 82 cases were included in the EA group,of which 13 had clinical classification of typeⅠand 69 had typeⅢ.The prenatal ultrasound examination showed that in typeⅠ,no tracheo-esophageal f

关 键 词：食管闭锁 超声检查 产前 羊水检测 甲胎蛋白 Γ-谷氨酰转移酶 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]