孕11～13^(+6)周产前超声诊断胎儿孤立性鼻骨异常的结局分析

Analysis of the outcome of fetal isolated nasal abnormality by ultrasonic diagnosis at 11-13^(+6) weeks of gestation

目的评估孕11~13^(+6)周产前超声诊断胎儿孤立性鼻骨异常的临床价值。方法回顾性分析有追踪结果的于2014年1月至2017年12月在宝安区妇幼保健院超声医学科常规进行孕11~13^(+6)周胎儿颈后透明层(NT)检查时被诊断为孤立性鼻骨异常的200例孕妇,将中孕期胎儿鼻骨发育情况与早孕期的诊断结果进行比较,探讨早孕期诊断孤立性鼻骨异常的真阳性。并将200例孕妇分为头臀长<56.2 mm组114例和头臀长≥56.2 mm组86例,采用χ~2检验比较不同头臀长组间提示孤立性鼻骨发育异常的真阳性率。结果 200例中178例于孕20~24周Ⅲ级检查时提示鼻骨正常89.0%(178/200),22例证实鼻骨发育不良,真阳性率为11.0%(22/200);头臀长<56.2 mm组鼻骨发育不良5例,真阳性率为4.39%(5/114),头臀长≥56.2 mm组鼻骨发育不良17例,真阳性率为19.77%(17/86),头臀长较大组的真阳性率明显比头臀长较小组,差异有显著统计学意义(P<0.01)。结论孕11~13^(+6)周超声提示孤立性鼻骨显示异常时胎儿鼻骨将有较大的机会在20周前发育完全。早孕期NT检查时,头臀长越大,诊断鼻骨异常的真阳性率越高。

Objective To evaluate the clinical value of ultrasonic diagnosis at 11-13＋6 weeks of gestation in fetal isolated nasal abnormality. Methods A total of 200 patients who underwent nuchal translucency（NT） examination and were diagnosed as fetal isolated nasal abnormality at 11-13＋6 weeks of gestation were enrolled. The development of the nasal bone in the middle pregnancy was compared with the diagnosis results in the early pregnancy to analyze the true positive of the diagnosis. The 200 fetuses were divided into two groups： the crown-rump length〈56.2 mm group（114 cases, group A） and the crown-rump length≥56.2 mm group（86 cases, group B）. χ2 test was used for comparison to analyze the true positive rate of fetal isolated nasal abnormality. Results Among the 200 cases, Ⅲ level examination at 20-24 weeks of gestation showed 178 cases（89.0%） of normal nasal bone and 22 cases（11.0%） of nasal bone dysplasia.There were 5 cases of nasal bone dysplasia in group A versus 17 cases in group B, and the true positive rate was 4.39%（5/114） in group A versus 19.77%（17/86） in group B（P〈0.01）. Conclusion There is still great chance that the fetal nasal bone will develop completely in 20 weeks even if fetal isolated nasal abnormality is found by ultrasonic diagnosis at 11-13＋6 weeks of gestation. However, the positive rate of abnormal nasal bone increases with the crown-rump length.