早孕期超声检测胎儿颈项透明层及鼻骨的临床意义

Clinical significance of ultrasonic testing of fetal nuchal translucency and nasal bone in early pregnancy

目的通过早孕期超声检测胎儿颈项透明层(NT)及鼻骨,探讨其在临床中的价值。方法选择2010年2月至2014年1月期间在甘肃省妇幼保健院产科进行产前检查的5 305例单胎妊娠孕妇采用彩色多普勒超声诊断仪检测NT的厚度并判定鼻骨有无。以NT厚度≥3mm作为NT增厚。结果在5 287例单胎孕妇中,发现62例NT值≥3mm,其中染色体核型异常5例,包括21-三体3例,18-三体1例,XXY1例。鼻骨缺失20例,其中染色体核型异常3例均为21-三体。检测NT增厚胎儿染色体异常检出率为8.06%,鼻骨缺失胎儿染色体异常检出率为15.00%。按孕11~11^(+6)周、孕12~12^(+6)周和孕13~13^(+6)周分成3组,各组间NT测量值比较差异有统计学意义(F=423.097,P<0.05)。按正常胎儿孕妇年龄段分为<25岁、25~29岁、30~34岁、≥35岁4组,各组间NT测量值比较差异无统计学意义(F=0.889,P>0.05)。结论 NT增厚及鼻骨缺失对于早期发现胎儿异常有较高的临床价值,早孕期超声筛查可成为一种独立的手段来评价早孕期的胎儿异常情况。

Objective To explore the clinical significance of ultrasonic testing of fetal nuchal translucency （NT） and nasal bone in early pregnancy. Methods For 5 305 cases with singleton pregnancy taking prenatal examination in obstetrics department of Gansu Provincial Maternity and Child-careHospital during the period of February 2010 to January 2014, Color Doppler ultrasound diagnostic system was used to measure the thickness of NT and detect the existence of nasal bone. NT thickness ≥3mm was regarded as thickened NT. Results Among 5 287 cases of pregnant women with single fetus, 62 cases were found with NT thickness ≥3mm, of which 5 cases were found with abnormal chromosome karyotype, including 3 cases of trisomy 21, 1 case of trisomy 18 and 1 case of XXY1. Twenty cases indicated absence of nasal bone, of which 3 cases of abnormal chromosome karyotype were trisomy 21. The detection rate of abnormal chromosome in thickened NT fetus reached 8.06% and 15.00% in fetus without nasal bone. All 5 287 cases of pregnant women were divided into three groups in accordance with gestational weeks, namely 11-11^＋6 week group, 12-12^＋6 week group and 13-13^＋6 week group. Differences among each group in NT value were statistically significant （ F = 423. 097, P 〈 0.05 ）. When dividing pregnant women with healthy fetus into 4 groups in accordance with their age, namely 〈25 group, 25 -29 year-old group, 30-34 year-old group and ≥35 group, differences among groups in NT value were of no statistical significance （ F = 0. 889, P 〉 0.05 ）. Conclusion Screening of thickened NT and absence of nasal bone is of great clinical significance to the early detection of abnormal fetuses. Ultrasonic screening could become an independent means to evaluate fetal abnormalities in early pregnancy.