摘要
目的探讨胎儿静脉导管多普勒血流频谱异常及颈项透明层(NT)增厚在早期胎儿先天性心脏畸形(CHD)筛查中的临床应用价值。方法对3562例孕11～14周的孕妇行常规产前检查,进行胎儿静脉导管多普勒血流频谱和NT检测,对静脉导管血流频谱异常或NT增厚胎儿于孕18～20周行超声心动图检查以确诊或除外CHD,对静脉导管血流频谱和NT正常的胎儿于20～24周行胎儿常规系统筛查,对可疑胎儿心脏异常者再行胎儿超声心动图检查。所有活产儿于出生后1周内进行超声心动图检查,对引产胎儿进行尸检。结果①3562例胎儿中静脉导管多普勒血流频谱异常胎儿CHD的发生率明显高于静脉导管多普勒血流频谱正常的胎儿(P<0.01),其敏感性、特异性及阳性预测值分别为55.22%、96.97%和25.87%;②NT增厚的胎儿CHD发生率明显高于NT正常胎儿(P<0.01),其敏感性、特异性及阳性预测值分别为49.25%、98.03%及32.35%;③静脉导管多普勒血流频谱异常和NT增厚的胎儿CHD发生率明显高于静脉导管多普勒血流频谱及NT均正常的胎儿(P<0.01),其敏感性、特异性及阳性预测值分别为43.28%、99.46%和60.42%。结论胎儿静脉导管多普勒血流频谱异常和NT增厚可作为CHD的早期筛查指标。
Objective To investigate the clinical application value of fetal abnormal Doppler blood flow spectrum of ductus venosus （DV） and increased nuchal translucency （NT） thickness in screening of early congenital heart disease（CHD）. Methods Fetal regular DV and NT measurements were performed on 3562 pregnant women within 11 - 14 gestational weeks. Those fetuses with abnormal Doppler blood flow spectrum of DV or increased NT thickness were examined by echocardiography duringl8 -20 gestational weeks to eliminate CHD. Those fetuses with normal Doppler blood flow spectrum of DV and normal NT were examined routinely during 20 - 24 gestational weeks. Echocardiography was performed on fetuses with suspected cardiac anomalies. All fetuses were followed up by eehocardiography during 1 weeks after birth, and those abortions accepted autopsy. Results （1）Compared with fetuses with normal DV, fetuses with abnormal DV showed significantly higher CHD incidence（ P 〈 0.01） Among 3562 cases. Its diagnostic sensitivity, specificity, and positive predictive value were 55.22%, 96.97%, 25.87%, respectively. （2）Compared with fetuses with normal NT thickness, fetuses with increased NT thickness showed significantly higher CHD incidence （ P 〈 0.01 ）. Its diagnostic sensitivity, specificity, and positive predictive value were 49. 25% , 98.03% , 32.35% , respectively. （3）Compared with fetuses with normal DV and NT thickness, fetuses with abnormal DV and increased NT thickness showed significantly higher CHD incidence（ P 〈 0.01 ）. Its diagnostic sensitivity, specificity, and positive predictive value were 43.28% , 99.46% , 60.42%, respectively. Conclusions Abnormal blood flow spectrum of DV and increased NT thickness can be used as early screening indicators of CHD.
出处
《临床超声医学杂志》
2012年第3期174-176,共3页
Journal of Clinical Ultrasound in Medicine
关键词
静脉导管
颈项透明层
心脏畸形
先天性
胎儿
Ductus venosus
Nuchal translucency
Heart abnormality
Congenital
Fetus
