产前超声监测胎儿心头比和颈项透明层厚度对产妇胎儿出生缺陷风险的评估

Prenatal ultrasound monitoring of fetal CBR and nuchal translucency thickness to evaluate the risk of fetal birth defects

目的评估产前超声监测胎儿心头比(CBR)和颈项透明层厚度(NT)在产妇胎儿出生缺陷风险的价值,促进优生。方法回顾性研究选取2016年2月至2020年5月中山市人民医院进行孕检确定为出生缺陷30例产妇作为患病组,选取同时期正常胎儿30例产妇作为对照组。采用彩色超声多普勒诊断仪进行产前检查,分析超声检查监测CBR和NT在胎儿出生缺陷中的诊断价值,运用ROC曲线分析超声诊断胎儿出生缺陷的AUC,并分析影响超声诊断胎儿出生缺陷符合率的因素。结果两组胎头双顶径(BPD)比较,差异无统计学意义(P>0.05),患病组头围(HD)、CBR和NT值明显高于对照组,差异有统计学意义(P<0.05);当CBR>0.33为截断值预测出生缺陷的敏感性为60.00%,特异性为80.00%,阳性预测值为75.00%,阴性预测值为66.67%。当NT>3 mm为截断值预测出生缺陷的敏感性为50.00%,特异性为96.67%,阳性预测值为93.76%,阴性预测值为65.91%。CBR和NT联合诊断出生缺陷的敏感性为80.00%,特异性为96.67%,阳性预测值为96.00%,阴性预测值为82.86%。本研究中超声检出缺陷率为93.33%(28/30),漏诊2例。以胎儿实际畸形为金标准,超声检查出生缺陷AUC为0.913(95%CI:0.169-0.956),灵敏度为93.33%,特异度为96.67%,准确度为95.00%,阳性预测值为96.55%,阴性预测值为93.55%。超声检查次数>1次、胎龄≥25周超声诊断符合率较高,差异有统计学意义(P<0.05)。结论CBR是孕期无创高效的检查指标,预测效能与NT相当。产前孕检次数、胎儿数、胎龄影响超声诊断出生缺陷符合率。

Objective To evaluate the value of prenatal ultrasound monitoring of fetal cardiobrainic ratio(CBR)and nuchal translucency thickness(NT)in the risk evaluation of fetal birth defects to promote better prenatal care.Methods In the retrospective study,30 parturients with fetal birth defects diagnosed by pregnancy examinations in Zhongshan People's Hospital from February 2016 to May 2020 were selected as the disease group,and 30 parturients with normal fetuses in the same period were selected as the control group.Prenatal examinations were performed with color Doppler ultrasound.The diagnostic value of ultrasound monitoring of CBR and NT in fetal birth defects was analyzed,the area under curve(AUC)of ultrasound diagnosis for fetal birth defects was analyzed by the receiver operating characteristic(ROC)curve and the factors influencing the coincidence rate of ultrasound diagnosis for fetal birth defects were analyzed.Results There was no statistically significant difference in biparietal diameter(BPD)between the two groups(P>0.05).The values of head circumference(HD),CBR and NT in the disease group were significantly higher than those in the control group,with statistically significant differences(P<0.05).When the cut-off value of CBR was>0.33,the sensitivity,specificity,positive predictive value and negative predictive value of predicting birth defects were 60.00%,80.00%,75.00%and 66.67%respectively.When the cut-off value of NT was>3 mm,the sensitivity,specificity,positive predictive value and negative predictive value of predicting birth defects were 50.00%,96.67%,93.76%and 65.91%respectively.The sensitivity,specificity,positive predictive value and negative predictive value in the combined CBR and NT diagnosis for birth defects were 80.00%,96.67%,96.00%and 82.86%respectively.In this study,the defect rate detected by ultrasound examinations was 93.33%(28/30),with 2 missed cases.Taking the actual fetal malformation as the golden standard,the AUC,sensitivity,specificity,accuracy,positive predictive value,negative predictive value of ultrasound examinations for birth defects were 0.913(95%CI:0.169-0.956),93.33%,96.67%,95.00%,96.55%,and 93.55%respectively.For>1 ultrasound examination and≥25 weeks of gestational age,the coincidence rate of ultrasound diagnosis was higher with a statistically significant difference(P<0.05).Conclusion CBR is a noninvasive and effective examination index in pregnancy,with equivalent predictive efficacy to NT.The frequency of prenatal examinations,the number of fetuses and gestational age can affect the coincidence rate of ultrasou nd diagnosis for birth defects.