二维超声在筛查重型α-地中海贫血胎儿的应用研究

Application of Two-Dimensional Ultrasound to Screening of Severe α-Thalassemia in Fetuses

目的分析重型α-地中海贫血(α地贫)胎儿的二维超声表现,探讨胎儿二维超声检查预测重型α地贫的价值。方法行羊膜腔穿刺术或脐血穿刺术、绒毛穿刺术后确诊重型α地贫且二维超声中有异常表现的胎儿139例(中晚孕胎儿108例,早孕胎儿31例),分析其二维超声的表现,并与正常对照组52例比较。结果 108例重型α地贫中晚期胎儿异常声像表现:胎儿心胸面积比值增大73.1%,胎儿宫内发育迟缓42.6%,胎儿浆膜腔积液36.1%,胎盘增厚35.2%,肠管回声增强29.6%,肝脾肿大17.6%,羊水量异常15.7%,胎儿水肿11.1%,脉络丛囊肿8.3%。31例早孕胎儿胎盘厚度大于正常对照组(P<0.05)。结论二维超声检查是预测重型α地贫胎儿的无创、有效筛查方法,适宜在基层医院推广。

Objective To analyze the two-dimensional ultrasound imaging of fetuses with severe α-thalassemia, and to investigate the clinical value of two-dimensional ultrasound in prediction of severe α-thalassemia in fetuses. Methods One hundred and thirty-nine fetuses with severe α-thalassemia（ 108 cases in middle and late gestation, and 31 cases in early gestation） were confirmed by amniocentesis or cordocentesis, chorionic villus sampling, and their abnormal imaging of two-dimensional ultrasound imaging,which was compared with that of normal control group（ n = 52）, was analyzed. Results Abnormal imaging of 108 fetuses with severe α-thalassemia in middle and late gestation was as follows： increased fetal cardiothoracic ratio （73. 1% ）, intrauterine growth retardation （42. 6% ）, serous cavity effusions （36. 1% ） ,increased placenta thickness （35.2%）, intestinal echo enhancement （29. 6% ）, hepatosplenomegaly （ 17.6% ）, abnormal amniotic fluid volume （ 15.7% ）, edema （ 11.1% ）, choroid plexus cysts （8.3%）. The placenta thickness of 31 fetuses in early gestation was greater than that of normal control group （P 〈0. 05 ）. Conclusion Two-dimensional ultrasound is a noninvasive and effective tool for the prediction of severe α-thalassemia in fetuses, which is suitable for basic level hospital.