五种胎儿头围正常参考值的适用性分析

Applicability of five fetal head circumference reference ranges

目的选择适用于评价广东胎儿头围发育水平的正常参考范围,为筛检小头胎儿提供依据。方法收集2012年9月至2016年12月期间在广东省妇幼保健院进行超声检查的13～40孕周的单胎胎儿头围数据,采用Kappa检验和约登指数比较5种常用的胎儿头围正常参考范围与实际数据的一致性,综合分析其筛检广东省小头胎儿的适用性。结果共收集18 269名13～40孕周的单胎胎儿头围数据,孕妇平均年龄为29岁,男胎和女胎的比例分别为53.1%和46.9%,籍贯为广东的胎儿占97.5%。中国胎儿发育参考值的总Kappa值和约登指数分别为0.86和0.97,均高于其余4种参考范围,但是在23、28、40孕周的约登指数偏低。在18～28孕周,白种人群的胎儿发育参考范围更接近实际检测值。结论中国胎儿正常参考范围与本地胎儿头围发育状况最为接近,但不适用于所有孕周,建议重新建立适用于本地的胎儿头围正常参考范围。

Objective To determine appropriate reference ranges for evaluating local fetal head circumference （HC）. Methods HC measurements of fetuses who accepted ultrasound detection from Sep- tember 2012 to December 2016 in our hospital were collected. Kappa value and Youden index were used to compare the consistency between the reference ranges and the actual data, and evaluate the sensitivity and specificity. Results Data on HC of singleton fetuses at 13-40 gestational weeks were collected. The aver- age age of the pregnant women was 29 years. The proportions of male and female fetuses were 53.1% and 46.9%, respectively, and 97.5% of the fetuses were from Guangdong. The Kappa value and Youden index of the Chinese national reference ranges were 0.86 and 0.97 respectively, higher than those of the other four reference ranges. But the Youden index was on the low side at 23, 28, and 40 gestational weeks.In 18 to 28 weeks, the reference ranges of fetal development in white population was doser to the actual detection value. Conclusions The Chinese national reference ranges of fetal HC are highly consistent with locl fetal HC, but not suitable for all gestational weeks. It was recommended to update the reference ranges for Guangdong fetuses.