胎儿心脏畸形孕早期筛查中脐静脉导管血流频谱参数与染色体异常的关系分析

Analysis of relationship between umbilical vein catheter blood flow spectrum parameters and chromosomal abnormalities in early pregnancy screening of fetal heart malformation

目的探讨胎儿心脏畸形孕早期筛查中脐静脉导管血流频谱参数与染色体异常的关系。方法本研究回顾性分析了2013年1月至2018年5月期间1326例孕11~14w胎儿的临床资料。采用GE E8型彩色多普勒超声诊断仪检查胎儿脐静脉导管血流频谱参数,其中包括心室收缩期波峰(S波)、心室舒张早期波峰(D波)、心房收缩期波峰(a波)、阻力指数(RI)、搏动指数(PI)和S/a比值。结果1326例孕11~14w胎儿中共有1267例为正常胎儿,59例为异常胎儿。随着孕周的升高,胎儿的RI、PI和S/a比值均逐渐降低。43例脐静脉导管异常胎儿中38例为a波反向,5例为a波消失。脐静脉导管异常组的胎儿异常率(18.60%)显著高于正常组(3.98%),差异有统计学意义(P<0.001)。脐静脉导管正常组和异常组的染色体异常具有显著差异(P<0.05)。脐静脉导管血流频谱参数诊断染色体异常的特异度为0.74%,阴性预测值为96.08%。结论在孕11~14w胎儿的早期筛查中,脐静脉导管血流频谱参数异常主要表现为a波反向和消失。脐静脉导管血流频谱参数诊断胎儿染色体异常的特异度和阴性预测值较高,可作为胎儿染色体异常早期筛查的诊断指标。

Objective:To investigate the relationship between blood flow spectrum parameters of umbilical vein catheter and chromosomal abnormalities in early pregnancy screening of fetal heart malformation.Methods:This study retrospectively analyzed the clinical data of 1326 fetuses aged 11-14 weeks between January 2013 and May 2018.The GE E8 color Doppler ultrasound diagnostic instrument was used to examine the blood flow spectrum parameters of the fetal umbilical vein catheter,including ventricular systolic peak(S wave),early ventricular diastolic peak(D wave),atrial systolic peak(a wave),resistance index(RI),pulsation index(PI)and S/a ratio.Results:A total of 1267 cases of normal fetuses in 1326 cases of 11-14 weeks of gestation were normal fetuses,and 59 cases were abnormal fetuses.With the increase of gestational age,the ratio of RI,PI and S/a of the fetus gradually decreased.Of the 43 cases of umbilical vein catheter abnormalities,38 cases had a wave reversal and 5 cases had a wave disappeared.The abnormal rate of fetal(85.60%)in the umbilical vein catheter abnormal group was significantly higher than in the normal group(3.98%),and the difference was statistically significant(P<0.001).There were significant differences in chromosomal abnormalities between the normal and abnormal groups of umbilical vein catheters(P<0.05).The specificity of umbilical vein blood flow spectrum parameters for diagnosing chromosomal abnormalities was 90.74%,and the negative predictive value was 96.08%.Conclusion:During the early screening of fetuses at 11-14 weeks of gestation,the abnormal parameters of blood flow parameters of umbilical vein catheter mainly manifested as a wave reversal and disappearance.The specificity and negative predictive value of umbilical vein catheter blood flow spectrum parameters for the diagnosis of fetal chromosomal abnormalities are high,which can be used as a diagnostic index for early screening of fetal chromosomal abnormalities.