胎儿静脉导管血流动力学检测在染色体异常筛查中的应用

Application of fetal ductus venous hemodynamics in screening of chromosomal abnormalities

目的:应用彩色多普勒超声检测胎儿静脉导管(DV)的血流频谱,探讨胎儿DV的血流动力学变化在染色体异常筛查中的应用。方法:采用彩色多普勒及脉冲多普勒超声检测产检指标正常组(320例,孕期11～40周)和产检指标异常组(48例,孕期11～35周)单胎胎儿的DV血流频谱,产检指标异常组需要进行胎儿染色体检查。观察胎儿的DV血流频谱波型(S波、D波和a波),产检指标异常组结合染色体核型分析。结果:胎儿的正常DV血流频谱表现为同向三相波,异常DV血流频谱表现为a波反向或消失。对48例产检指标异常组的单胎胎儿进行染色体核型分析,其中染色体异常组12例(10例DV异常,2例DV正常),染色体正常组36例(11例DV异常,25例DV正常)。染色体异常组中DV血流频谱异常检出率高于染色体正常组(X^2=9.723,P=0.002)。结论:胎儿DV血流频谱异常可增加胎儿染色体异常的检出率,超声检测可以作为早孕期染色体异常筛查的初步判断依据。

Objective:To detect the blood flow sepectrum of fetal ductus venosus(DV)with color Doppler ultrasound,and to explore the application of the fetal DV in screening the chromosome abnormalities.Methods:The blood flow spectra of fetal DV in antenatal examination normal group(320 cases,with 11-40 weeks of gestation)and antenatal examination abnormal group(48 cases,within 11-35 weeks of gestation)were detected with color Doppler and pulse Doppler ultrasound,and chromosome examination was performed in abnormal group.The fetal DV blood flow patterns(S wave,D wave,a wave)were observed,and karyotype analysis was performed in abnormal group.Results:The normal Doppler spectrum of the DV in fetuses showed the same three-phase waves while the abnormal Doppler spectrum of the DV in fetuses showed a wave reserved or absented.A total of 48 cases of chromosome in abnormal group were examined;12 cases of chromosome abnormality were found in this study(10 cases of DV abnormality and 2 cases of DV normality).A total of 36 cases of normal chromosomes were found which(11 cases of abnormal DV and 25 cases of normal DV).The abnormal detection rate of DV blood flow spectrum in chromosome abnormal group was higher than that in chromosome normal group(χ^2=9.723,P=0.002).Conclusion:The abnormality of fetal DV blood flow spectrum can increase the detection rate of chromosome abnormalities and ultrasonography could be used as the primary basis for screening the chromosome abnormality in early pregnancy..