分析实时动态四维彩超联合母体血清叶酸和维生素B12水平检测在孕中期胎儿中枢神经系统畸形的诊断

Diagnostic Value of real-time dynamic four-dimensional color Doppler ultrasound combined with detection of maternal serum folate and vitamin B12 levels in fetal central nervous system malformations in the second trimester of pregnancy

目的探讨孕中期胎儿中枢神经系统畸形诊断中实时动态四维彩超联合母体血清叶酸、维生素B12(VB12)检测的应用价值。方法对医院2015年1月~2017年12月接收的100例孕中期可疑胎儿中枢神经系统畸形的母体及胎儿临床资料进行回顾性分析,均接受跟踪随访,均明确胎儿中枢神经系统畸形发生情况。将随访结果作为"金标准",统计胎儿中枢神经系统畸形的情况,了解实时动态四维彩超检查情况,对比发生者和未发生者母体血清叶酸、VB12水平。评价实时动态四维彩超、母体血清叶酸水平、母体血清VB12水平及实时动态四维彩超联合母体血清叶酸、VB12水平对孕中期胎儿中枢神经系统畸形的诊断价值。结果本组受试者中共有22例经随访确诊为胎儿中枢神经系统畸形,发生率为22.00%,共有27例胎儿经实时动态四维彩超检查拟诊断为中枢神经系统畸形;发生者母体血清叶酸、VB12水平均明显低于未发生者母体血清叶酸、VB12水平(P<0.05);实时动态四维彩超联合母体血清叶酸、VB12诊断孕中期胎儿中枢神经系统发育畸形的AUC、灵敏度、特异度分别为0.926、81.82%、89.74%,均高于单纯实时动态四维彩超、母体血清叶酸水平、母体血清VB12水平诊断。结论孕中期胎儿中枢神经系统畸形者母体血清叶酸、VB12水平均较低,且实时动态四维彩超联合母体血清叶酸、VB12水平在孕中期胎儿中枢神经系统畸形诊断的价值较高。

Objective:To explore the diagnostic Value of real-time dynamic four-dimensional color Doppler ultrasound combined with detection of maternal serum folate and vitamin B12(VB12)levels in fetal central nervous system malformations in the second trimester of pregnancy.Methods:A retrospective analysis of maternal and fetal clinical data of 100 cases of suspected central nervous system malformations in the second trimester of pregnancy admitted by our hospital from January 2015 to December 2017 was made.All patients were followed up.The central nervous system abnormalities were identified.The following-up results were taken as the"gold standard".The fetal central nervous system abnormalities were noted,and the understand the real-time four-dimensional color Doppler ultrasound examination were carried out.The maternal serum folate and VB12 levels were compared between the occurrence and non occurrence.The diagnostic value of real-time dynamic four-dimensional color Doppler ultrasound,maternal serum folic acid level,maternal serum VB12 level and maternal serum folic acid and VB12 levels in fetal central nervous system malformation in the second trimester of pregnancy were evaluated.Results:In this group,22 cases were diagnosed as fetal central nervous system malformation after following-up,the incidence was 22.00%.A total of 27 fetuses were diagnosed with central nervous system malformations by real-time four-dimensional color Doppler ultrasound.The serum folate and VB12 levels of the pregnant women were significantly lower than those of those who did not(P<0.05).The sensitivity and specificity of real-time dynamic four-dimensional ultrasound combined with maternal serum folic acid and VB12 levels in the diagnosis of central nervous system malformations during the second trimester of pregnancy were 0.926,81.82%and 89.74%respectively,which were all higher than those of simple real-time dynamic four-dimensional color Doppler ultrasound,maternal serum folic acid level and maternal serum VB12 level.Conclusion:The maternal serum levels of folic acid and VB12 were lower in patients with central nervous system malformations in the second trimester of pregnancy,and the value of real-time dynamic four-dimensional ultrasound combined with maternal serum levels of folic acid and VB12 in the diagnosis of central nervous system malformations in the second trimester of pregnancy was higher.