三维超声评估胎儿耳廓对先天性外耳道闭锁的预测价值  

Three-dimensional ultrasonography assessment of fetal auricle for predicting congenital aural atresia

作　　者：刘酉璐 雷婷[1] 姜雨汀 郑菊[1] 郑巧 何苗[1] 张立鹤 谢红宁[1] Liu Youlu;Lei Ting;Jiang Yuting;Zheng Ju;Zheng Qiao;He Miao;Zhang Lihe;Xie Hongning(Department of Ultrasonic Medicine,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院超声医学科,广州510080

出　　处：《中华超声影像学杂志》2025年第2期155-160,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82171938,82202156,81801705);广东省企联合基金面上项目(2022A1515220200);广州市科技计划项目(202201011238)。

摘　　要：目的探讨三维超声评估胎儿耳廓形态及大小对先天性外耳道闭锁(CAA)的预测价值。方法回顾性收集2018年1月至2023年12月于中山大学附属第一医院行产前超声检查并留存有耳廓三维超声图像的227例胎儿,根据出生后外耳道是否闭锁将其分为CAA组(52例,62只耳廓)及非CAA组(175例,202只耳廓)。根据耳廓轮廓三维表面成像特征将胎儿耳廓分为4型:Ⅰ型为C形耳廓、有耳甲;Ⅱ型为不规则形耳廓、有耳甲;Ⅲ型为C形耳廓、无耳甲;Ⅳ型为不规则形耳廓、无耳甲。测量耳廓长度(AL)、耳廓宽度(AW),并计算耳廓长宽积(ALW),建立非CAA组ALW的正常参考值范围。比较两组间耳廓分型、ALW对应孕周的Z-score值(ALWZ)的差异。利用ROC曲线分析耳廓分型、ALWZ和联合模型的诊断效能。建立耳廓分型联合ALWZ预测CAA的Logistic回归模型。结果CAA组与非CAA组间耳廓分型及ALWZ差异有统计学意义(均P<0.001)。耳廓分型、ALWZ预测CAA的AUC分别为0.960(95%CI=0.923~0.997)与0.975(95%CI=0.959~0.991)。联合耳廓分型和ALWZ的Logistic回归模型(5.379×形态指标-2.386×ALWZ-5.790)拟合良好(R^(2)=3.181,P=0.922),其预测CAA的AUC为0.993(95%CI=0.983~1.000),优于单一指标。结论产前超声评估耳廓形态及大小可有效预测CAA。Objective To explore the value of prenatal three-dimensional ultrasonography(3DUS)in displaying auricular morphotyping and dimensions for predicting congenital aural atresia(CAA).Methods A retrospective collection of 227 fetuses who underwent ultrasound scans and retained auricular 3DUS volumes from January 2018 to December 2023 at the First Affiliated Hospital of Sun Yat-sen University was conducted.Fetuses were divided into two groups:a CAA group(52 fetuses,62 auricles)and a non-CAA group(175 fetuses,202 auricles),based on the presence or absence of external auditory canal identified through postnatal examination.According to 3DUS auricular contour and presence or absence of the concha,the auricles were divided into 4 types:type I,C-shaped auricle with a concha;type II,Irregular auricle with a concha;type II,C-shaped auricle without a concha;type IV,Irregular auricle without a concha.And auricular length(AL)and width(AW)were measured to calculate the product of the auricular length and width(ALW).Normal reference ranges for ALW from the non-CAA group were developed.Differences of the auricular morphotyping and Z-score of ALW(ALWZ)were compared between the two groups.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficiency of auricular morphotyping,ALWZ and the regression model.A Logistic regression model for CAA based on auricular morphotyping and ALWZ were established.Results The auricular morphotyping and ALWZ between the two groups were different statistically(both P<0.05).The AUC of the auricular morphotyping and ALWZ predicting CAA were 0.960(95%CI=0.923-0.997)and 0.975(95%CI=0.959-0.991)individually.Formula for CAA prediction model combining the two indicators(5.379 × morphotyping-2.386×ALWZ 5.790)showed good performance(R^(2)=3.181,P=0.922).The AUC of the combined model was 0.993(95%CI=0.983-1.000),which was superior to single indicators.Conclusions The auricular morphotyping and dimensions can effectively predict CAA.

关 键 词：超声检查 产前 先天性外耳道闭锁 耳廓形态 耳廓大小 

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