摘要
目的探讨核磁共振联合超声及母体血清筛查在胎儿中枢神经系统畸形中的诊断效果及价值。方法选择2018年12月-2019年12月疑似胎儿中枢神经系统畸形并在医生指导下完成产前筛查的孕妇112例作为对象,所有胎儿均最终得到确诊(金标准),确诊前均完成超声检查、核磁共振检查,并将核磁共振检查、超声检查结果与金标准进行比较;检测孕妇甲胎蛋白(AFP)、血清人绒毛膜促性腺激素游离β亚基(Freeβ-hCG)及雌三醇(uE3)水平;绘制ROC曲线,分析核磁共振联合超声及母体血清在胎儿中枢神经系统畸形中的诊断效能。结果112例产前筛查的孕妇最终确诊中枢神经系统畸形17例,确诊率为15.18%;中枢神经系统畸形排在前两位的分别为脑积水及脊柱裂,分别占:29.41%和23.53%;17例确诊的中枢神经系统畸形胎儿中超声检查确诊12例,诊断符合率为70.59%(P<0.05);核磁共振检查确诊15例,确诊率为88.24%(P>0.05);核磁共振联合超声检查确诊17例,诊断符合率为100.0%(P>0.05);17例胎儿中枢神经系统畸形中,经母体血清学筛查最终确诊胎儿中枢神经系统畸形8例,患者MOM值异常,6例为染色体异常,2例为地中海贫血性水肿;ROC曲线结果表明:核磁共振联合超声、母体血清筛查在胎儿中枢神经系统畸形中诊断敏感性、特异性,高于单一核磁共振、超声、母体血清筛查(P<0.05)。结论核磁共振联合超声、母体血清筛查用于胎儿中枢神经系统畸形中能获得较高的检出率,且不同方法的联合使用能提高诊断效能,能为临床诊疗提供依据、参考,值得推广应用。
Objective:To investigate the diagnostic effect and value of nuclear magnetic resonance(MRI)combined with ultrasound and maternal serum screening in fetal central nervous system malformations.Methods:112 pregnant women with suspected fetal central nervous system malformation and completed prenatal screening under the guidance of doctors from December 2018 to December 2019 were selected as the objects.All the fetuses were finally diagnosed(gold standard).Before diagnosis,ultrasound examination and nuclear magnetic resonance examination were completed,and the results of nuclear magnetic resonance examination and ultrasound examination were compared with the gold standard;alpha fetoprotein of pregnant women was detected(Methods:the levels of AFP,freeβ-hCG and UE3 in serum were measured.The ROC curve was drawn to analyze the diagnostic efficacy of MRI combined with ultrasound and maternal serum in fetal central nervous system malformation.Results:Among 112 cases of prenatal screening,17 cases were diagnosed with central nervous system malformation,the diagnosis rate was 15.18%;the top two types of central nervous system malformations were hydrocephalus and spina bifida,accounting for 29.41%and 23.53%respectively;among the 17 cases diagnosed with central nervous system malformation,12 cases were diagnosed by ultrasonography,and the diagnostic coincidence rate was 70.59%(P<0.05);15 cases were confirmed by MRI The diagnosis rate was 88.24%(P>0.05);17 cases were diagnosed by nuclear magnetic resonance combined with ultrasound,and the diagnostic coincidence rate was 100.0%(P>0.05);among the 17 cases of fetal central nervous system malformation,8 cases were diagnosed as fetal central nervous system malformation by maternal serological screening,with abnormal mom value,6 cases with chromosomal abnormalities,and 2 cases with thalassemia edema.The results of ROC curve showed that:MRI was an effective method to diagnose fetal central nervous system malformation The sensitivity and specificity of combined ultrasound and maternal serum screening in the diagnosis of fetal central nervous system malformation were higher than those of single MRI,ultrasound and maternal serum screening(P<0.05).Conclusion:MRI combined with ultrasound and maternal serum screening can obtain a high detection rate in fetal central nervous system malformation,and the combined use of different methods can improve the diagnostic efficiency,and can provide basis and reference for clinical diagnosis and treatment,which is worthy of promotion and application.
作者
张连香
贾秋桦
孙美英
ZHANG Lian-xiang;JIA Qiu-hua;SUN Mei-ying(Linyi maternal and child health care hospital,Linyi 276000)
出处
《中国优生与遗传杂志》
2020年第7期882-885,共4页
Chinese Journal of Birth Health & Heredity
关键词
核磁共振
超声
母体血清筛查
胎儿中枢神经系统畸形
诊断效能
Nuclear magnetic resonance
Ultrasound
Maternal serum screening
Fetal central nervous system malformation
Diagnostic efficiency
