产前超声检查在Hb Bart′s胎儿水肿综合征中的预测价值

Predictive Value of Prenatal Ultrasound in Hb Bart′s Fetal Hydrops Syndrome

目的:探讨产前超声检查在Hb Bart′s胎儿水肿综合征中的预测价值。方法:回顾分析2012年至2018年在我院行介入性产前诊断确诊为Hb Bart′s胎儿水肿综合征206例的超声表现。分析其早孕期颈后透明层(NT)和心胸横径比值(CTR),以及中晚孕期的CTR、大脑中动脉收缩末期峰值流速(MCA-PSV)及其他异常。结果:孕妇平均年龄为27.5±4.9岁,行介入性产前诊断时平均孕周为18.3±5.4周。早孕期NT增厚发生率为26.3%(15/57),而CTR增大占70.5%(24/34);在中晚孕期,孕14~24周CTR增大占96.1%(98/102),而孕24周以后,所有病例均出现CTR增大(34/34);中晚孕期MCA-PSV升高仅占56.6%(56/99),胎盘增厚仅占25.6%(31/121)。有19.5%(29/149)出现水肿综合征,最早发生于孕16+4周;25.5%(38/149)出现单个体腔积液;31.5%(47/149)出现骨发育异常,其中长骨发育异常(<第5百分位)占28.2%。结论:产前超声检查是监测Hb Bart′s胎儿水肿综合征的一种无创可重复的检查方法,在整个孕期CTR对该病的预测价值最大,中晚孕期MCA-PSV是一个比较敏感的指标,而NT增厚和胎盘增厚仅起到一定的预测作用。

Objective:To investigatethe predictive value of prenatal ultrasound in Hb Bart′s fetal hydrops syndrome.Methods:The ultrasound findings of Hb Bart′s fetal hydrops syndrome diagnosed by invasive prenatal diagnosis in our hospital from 2012 to 2018 were retrospectively analyzed.These cases were analyzed for nuchal translucency thickness(NT)and cardiothoracic ratio(CTR)in the first trimester,as well as CTR,middle cerebral artery peak systolic velocity(MCA-PSV)and other abnormalities in the second and third trimester.Results:The average age of pregnant women was 27.5±4.9 years old.The average prenatal diagnosis gestational age was 18.3±5.4 weeks.The rate of increased NT was 26.3%(15/57),and the rate of CTR enlargement was 70.5%(24/34)in the first trimester.However,CTR enlargement rate was 96.1%(98/102)during 14-24 weeks of pregnancy,and all cases showed an increased CTR(34/34)after 24 weeks of gestation,and the rate of increased MCA-PSV was only 56.6%(56/99).While the rate of increased placental thickness was only 25.6%(31/121).29 cases(19.5%,29/149)were appearededema syndrome,the earliest one was at 16+4gestational week.25.5%(38/149)cases had a single body cavity effusion.47 cases(31.5%,47/149)were found bone dysplasia,of which long bone dysplasia(<5 th percentile)accounted for 28.2%.Conclusions:Prenatal ultrasonography is a non-invasive and repeatmethod for monitoring Hb Bart′s hydrops syndrome.The predictive value of CTR is the greatest in the whole pregnancy.MCV-PSV is a sensitive indicator in the middle and late pregnancy.NT and placental thickness only play a certain predictive role.