二维超声和四维超声应用于产前诊断中对胎儿畸形筛查的价值

Screening Value of Two-Dimensional Ultrasonography and Four-Dimensional Ultrasonography Applied in the Prenatal Diagnosis of Fetal Malformation

目的探讨二维超声和四维超声应用于产前诊断中对胎儿畸形筛查的价值。方法选取2014年1月至2016年12月于我院行产前超声筛查的孕妇879例作为研究对象,均进行二维超声和四维超声筛查,以终止妊娠或胎儿出生后随访结果为"金标准",判定并比较二维超声和四维超声在产前诊断中对胎儿畸形筛查的灵敏度、特异性、阳性符合率。结果 879例产前筛查孕妇,经"金标准"明确诊断38名先天性畸形胎儿,发生率为4.32%。二维超声诊断灵敏度为60.53%,特异性为99.05%,阳性符合率为97.38%;四维超声诊断灵敏度为89.47%,特异性为99.64%,阳性符合率为99.20%。四维超声在产前胎儿畸形筛查中的灵敏度、阳性符合率显著高于二维超声(P<0.05),四维超声和二维超声在产前胎儿畸形筛查中的特异性无统计学差异(P>0.05)。结论四维超声在产前诊断胎儿畸形中较二维超声具有更高的灵敏度和阳性符合率,临床中对于二维超声筛查异常者应采取四维超声进一步筛查,以提高产前胎儿畸形筛查的准确率。

Objective To explore the screening value of two-dimensional ultrasonography and four-dimensional ultrasonography applied in the prenatal diagnosis of fetal malformation. Methods 879 cases ofpregnant women with prenatal ultrasound screening from January 2014 to December 2016 in our hospital were selected and screened by two-dimensional ultrasound and four-dimensional ultrasound. With the results of termination of pregnancy or fetal follow-up as ＂gold standard＂, the sensitivity, specificity and positive coincidence rate of two-dimensional ultrasound and four-dimensional ultrasound in prenatal diagnosis of fetal malformations were determined and compared. Results In 879 pregnant women with prenatal screening, 38 cases ofcongenital malformations were clearly diagnosed by ＂gold standard＂, with the incidence of 4.32%. The diagnostic sensitivity of the two-dimensional ultrasound was 60.53%, the specificity was 99.05%, and the positive coincidence rate was 97.38%. The diagnostic sensitivity of four-dimensional ultrasound was 89.47%, the specificity was 99.64%, and the positive coincidence rate was 99.20%. The sensitivity and positive coincidence rate of four-dimensional ultrasound in the prenatal fetal malformation screening were significantly higher than those of two-dimensional ultrasound （39〈0.05）. No significant difference was found in the diagnostic specificity between four-dimensional ultrasound and two-dimensional ultrasound in prenatal fetal malformation screening （P〉0.05）. Conclusions Four-dimensional ultrasound has higher sensitivity and positive coincidence rate than two-dimensional ultrasound in the prenatal diagnosis of fetal malformation screening. In clinical practice, four-dimensional ultrasound should be used for further screening of those with abnormalities in two-dimensional ultrasound screening, so as to improve the accuracy of prenatal fetal malformation screening.