彩色多普勒超声对胎儿颈项透明层增厚检测在胎儿异常中的诊断价值

The diagnostic value of color Doppler ultrasound in the detection of fetal cervical transparent layer thickness detection in fetal abnormality

目的探讨彩色多普勒超声对胎儿颈项透明层增厚检测在胎儿异常中的诊断价值。方法随机选取2014年9月-2017年9月期间在我院行彩色多普勒超声检查的妊娠早期(11-13+6w)孕妇,对所有胎儿行颈项透明层测量,其中80例颈项透明层增厚产妇作为研究组,并随机选取同期颈项透明层厚度正常产妇80例作为正常组,研究组颈项透明层厚度大于3.0mm,正常组颈项透明层厚度小于3.0mm,观察彩色多普勒超声诊断的敏感性和特异性,比较两组染色体异常检出情况,并比较年龄、孕周与染色体异常检出率的关系,并对颈项透明层增厚和染色体异常检出率行pearson相关分析。结果研究组颈项透明层厚度明显高于对照组,差异有统计学意义(P<0.05);研究组检出染色体异常15例,占18.75%,其中染色体非整倍体9例,染色体异常21三体3例,染色体异常18三体1例,染色体结果异常2例;正常组检出染色体异常4例,占5%,其中染色体非整倍体1例,性染色体异常1例,染色体结构异常1例。两组差异有统计学意义(P<0.05);颈项透明层增厚孕妇随着年龄增加,染色体异常检出率呈不断上升趋势,差异有统计学意义(P<0.05);孕11-13+6w,研究组颈项透明层厚度均厚于正常组,差异有统计学意义(P<0.05);随着颈项透明层增加,灵敏度、阴性预测值逐渐降低,而特异度、阳性预测值则不断升高;通过pearson相关分析显示,随着颈项透明层增厚,其染色体异常检出率逐渐上升,颈项透明层增厚和染色体异常检出率呈正相关(OR=5.136),差异有统计学意义(P<0.05)。结论彩色多普勒超声对胎儿颈项透明层增厚检测可作为妊娠早期胎儿染色体异常筛查指标,颈项透明层是产前检查重要检测指标,随着颈项透明层增厚,染色体异常检出率逐渐上升,导致胎儿不良妊娠结局发生率不断升高,值得临床进一步推广。

Objective： To explore the diagnostic value of color doppler ultrasonography for fetal cervical transparent layer thickening detection in fetal abnormality. Methods：Randomly selected in September 2014-September 2017 in our hospital during the period of color Doppler ultrasound examination of early pregnancy（11-13＋6）weeks pregnant,to measure all fetal line neck transparent layer,including 80 cases of neck transparent layer thickening of maternal as a team,and in the same period were randomly selected neck normal transparent layer thickness,80 cases of maternal as normal group,the group at the neck is a transparent layer thickness is greater than 3.0 mm,normal neck transparent layer thickness is less than 3.0 mm,observation of color doppler ultrasonic diagnostic sensitivity and specificity,comparing two groups of chromosome anomaly detection,and compare the age,gestational age,and the relationship between chromosome anomaly detection,and thickening of the neck is a transparent layer and chromosome anomaly detection line Pearson correlation analysis. Results：The thickness of the cervical transparent layer was significantly higher than that in the control group. The study group detected 15 cases of chromosome abnormality,accounting for 18.75%,including 9 cases of chromosome abnormality,3 cases of chromosome abnormality,3 cases of chromosome abnormality,1 case of chromosome abnormality,and 2 cases of abnormal chromosome results. In the normal group,chromosome abnormality was detected in 4 cases,accounting for 5%,including 1 case of chromosome aneuplosis,1 case of sex chromosome abnormality,and 1 case of chromosome abnormality. The difference between the two groups was statistically significant（P〈0.05）. The incidence of chromosomal abnormalities increased with age（P〈0.05）. During the 11-13＋6 weeks of pregnancy,the thickness of the cervical transparent layer in the observation group was thicker than that of the normal group（P〈0.05）. With the increase of the transparent layer of the neck,the sensitivity and negative predictive value decreased gradually,while the specificity and positive predictive value kept rising. Through the Pearson correlation analysis showed that as the neck is transparent layer thickening,its abnormal chromosome detection rates rise gradually,neck is transparent layer thickening and abnormal chromosome detection rates were positively correlated（OR=5.136）,the difference was statistically significant（P〈0.05）. Conclusion：Transparent layer of color doppler flow imaging（cdfi）in neck thickening detection can be used as screening for fetal chromosomal abnormalities during early pregnancy indicator,neck antenatal examination is important to the transparent layer test indicators,with the neck is transparent layer thickening,abnormal chromosome detection rates gradually rise,lead to rising incidence of fetal adverse pregnancy outcomes,is worth further promotion in the clinical practice.