颈项透明层增厚胎儿的临床结局分析

Clinical outcome analysis of fetuses with thickened nuchal translucency

目的研究颈项透明层（NT）增厚胎儿的临床结局，探讨超声测量NT厚度在评估胎儿预后中的临床价值。方法对11～13＋6周，头臀径为45～84mm的4081例胎儿常规进行NT的测量，NT≥2．5mm视为增厚，随访观察NT增厚胎儿的临床结局。将NT厚度分为4组（A组：2．5～3．4mm，B组：3．5—4．4mm，C组：4．5～5．4mm及D组：5．5～6．4mm），不同NT厚度胎儿的临床结局的比较采用Ridit分析，并应用等级相关分析NT增厚与胎儿健康存活率的相关性。结果超声共检出58例NT增厚胎儿，其中6例NT≥6．5mm，均于早孕期行人工流产终止妊娠，余52例NT〈6．5mm，其中4例染色体异常，10例染色体正常但合并畸形或遗传综合征，1例中孕早期停止发育，33例至出生未见异常，4例失访。不同NT厚度胎儿的临床结局差异有统计学意义（P〈0．05），随NT增厚程度的增加，胎儿健康存活率呈降低的趋势[A组：81．8％（27／33），B组：62．5％（5／8），C组：25％（1／4），D组：0％（0／3），r=0．993，P〈0．05]。结论超声测量NT厚度对于临床早期评价胎儿的预后有重要参考价值。

Objective To study the clinical outcome of fetus with thickened nuchal translucency, and to explore the clinical value of ultrasonography in testing nuehal translucency （NT） thickness for evaluating fetal prognosis. Methods NT test was routinely performed in 4081 fetuses between 11- 13 ^＋ 6 weeks of gestation and with head-buttock length between 45-84 mm. Fetuses would be taken with thickened NT if NT thiekness≥2.5 mm. The clinical outcome of fetuses with NT thickness was followed up. The NT thickness was classified into four groups （Group A： 2.5-3.4mm, Group B： 3.5-4.4 mm, Group C： 4.5-5.4 mm and Group D： 5.5-6.4 mm）. Ridit analysis was used for comparing the clinical outcomes of fetuses with various NT thickness, and rank correlation analysis was applied for analyzing correlation of NT thickness with fetuses survival rate. Results Thickened NT was observed in 58 fetuses by ultrasound, of whom, NT≥ 6.5 mm appeared in 6, and these 6 cases were aborted during early pregnancy. The other 52 cases had NT 〈 6.5 mm, 4 of whom had chromosomal abnormalities, 10 cases were with normal chromosomes but accompanied by malformation or genetic syndrome, 1 case ceased development in the first trimester, no abnormity to birth was observed in other 33 cases and 4 cases lost follow up. The clinical outcomes in fetus with various NT thickness had significant differences （P〈0.05）. Survival rate of fetuses decreased as NT thickened [Group A： 81.8% （27/33）, Group B： 62.5%（5/8）, Group C： 25% （1/4）, Group D： 0% （0/3）, r=-0.993, P〈0.05 ]. Conclusion Ultrasonography for testing NT thickness is an important reference value for making early evaluation on prognosis of fetuses in clinical.