超声检测重型α-地中海贫血胎儿脾动脉流速变化的研究

Splenic artery doppler peak velocity studies in the evaluation of Henoglobin bart disease

目的探讨胎儿脾动脉收缩期峰值流速(Sp A-PSV)预测重型α-地中海贫血(简称α-地贫)的临床意义。方法2012年1月至2014年1月在广东省妇幼保健院门诊检查的孕妇,采用彩色多普勒超声检测单胎孕18~39周共607例胎儿的Sp A-PSV值,正常组457例,观察组150例。正常组孕中期196例,孕晚期261例;观察组根据α-地贫基因类型分为非重型组105例与重型组45例,其中非重型组孕中期96例,孕晚期9例;重型组孕中期32例,孕晚期13例。采用两因素方差分析组别及孕期的主效应和交互效应。结果正常组、非重型组、重型组的主效应差异有统计学意义(F=18.832,P<0.001),孕期的主效应具有统计学意义(F=96.374,P<0.001),组别与孕期的交互效应也具有统计学意义(F=4.664,P=0.010)。正常组中,不同孕期Sp A-PSV的差异有统计学意义(t=13.549,P<0.001);非重型组中,不同孕期的差异也有统计学意义(t=19.117,P<0.001);重型组中,不同孕期的差异同样有统计学意义(t=6.663,P<0.001)。孕中期,3组间Sp A-PSV的差异有统计学意义(F=8.294,P<0.001),两两比较,重型组[(30.97±4.32)cm/s]相比正常组[(26.02±9.01)cm/s]和非重型组[(24.71±4.41)cm/s]Sp A-PSV值显著增高,差异有统计学意义(P<0.05),正常组相比非重型组差异无统计学意义。孕晚期,Sp A-PSV值3组间差异有统计学意义(F=10.440,P<0.001),重型组[(53.26±9.77)cm/s]相比正常组[(38.34±10.11)cm/s]和非重型组[(34.92±0.86)cm/s]Sp A-PSV值显著增高,差异有统计学意义(P<0.05),正常组相比非重型组差异无统计学意义。结论重型α-地贫胎儿在孕中晚期的Sp A-PSV值相比非重型α-地贫、正常胎儿均显著升高,提示超声多普勒测量Sp A-PSV值预测重型α-地中海贫血具有临床意义,为临床上筛查或监测重型α-地贫胎儿值得推荐的一种非侵入性方法。

Objective To research the different changes of SpA-PSV in the groups of normal fetuses, fetuses with Henoglobin bart disease and fetuses without Henoglobin bart disease.Methods This study was conducted on uncomplicated singleton pregnancies with normal fetuses（control group,457 fetuses）and pregnancies at risk for fetal Hb bart disease（Experimental group,150 fetuses）scheduled for cordoeentesis at 18 to 39 weeks＇ gestation at Guangdong Women and Children Hospital were recruited into the study. The control group 196 cases in second trimester,261 cases in late pregnancy,The Experimental group were divided into two groups（without homozygous c^-thalassemia, homozygous a-thalassemia）,The group without homozygous c^-thalassemia 96cases in second trimester, 9cases in late pregnancy;The group homozygous ^-thalassemia 32cases in second trimester,13cases in late pregnancy.The Doppler measurements of SpA-PSV were performed by the sonographers with the high-resolution machine.The Experimental group SPA-PSV was measured before cordocentesis and the final fetal diagnosis of Hb bart disease was based on fetal Hb typing using high- performance liquid chromatography.the relationship SpA-PSV was using two-way ANOVA analysis. Results The main effect of among the groups normal fetuses, fetuses with Henoglobin bart disease and fetuses without Henoglobin bart disease with statistical significance （F=96.374, P〈0.001）. The main effect of pregnancy with statistical significance （F=96.374, P〈0.001） , the cross- over- effect of groups and pregnancy with statistical significance （F=4.664, P=0.010）. In the normal fetuses, statistically significant differences between the pregnancy （t=13.549, P〈0.001）. In the fetuses without Henoglobin hart disease are statistically significant differences between the pregnancy （t=19.117, P〈 0.001）. In the fetuses with Henoglobin bart disease are statistically significant differences between the pregnancy （t= 6.663, P〈0.001）. in second trimeste, group differences statistically significant （F=8.294, P〈0.001）, fetuses with Henoglobin hart disease compared with the normal fetuses with statistical significance （P〈0.05）, compared with fetuses without Henoglobin bart disease no statistical significance.In late pregnancy, group differences statistically significant （F=10.440, P〈0.001）, fetuses with Henoglobin bart disease compared with the normal fetuses with statistical significance （P〈0.05）, and normal fetuses compared with the fetuses without Henoglobin bart disease no statistical significance. The SPA PSV of the with homozygousct-thalassemia fetuses was higher than that without homozygous α-thalassemi. Conclusion The SpA-PSV of the fetuses with Henoglobin bart disease was higher than that of the fetuses without Henoglobin bart disease It＇ s important to check and measure SpA-PSV, which can identify fetuses with Hb bart disease and instruct the clinical treatment.