早孕期胎儿超声软指标与不良妊娠结局的关系

Relationship between fetal ultrasonic soft markers and adverse pregnancy outcomes during the first trimester

目的探讨早孕期(孕11~13+6周)超声筛查发现的超声软指标与胎儿妊娠结局的关系。方法选取2017年8月至2020年8月中国早孕期超声筛查多中心临床研究项目中的单胎妊娠胎儿,分析早孕期软指标的种类及检出率,并采用二元Logistic回归分析研究软指标与不良妊娠结局的相关性。结果16625例胎儿有完整随访结局并入组。早孕期556例超声软指标阳性胎儿中共检出607个超声软指标,发生率较高的前四位分别为颈项透明层(nuchal translucency,NT)增厚(2.08%,345/16625)、心室点状强回声(0.94%,156/16625)、鼻骨发育不良(0.20%,34/16625)、单脐动脉(0.19%,31/16625)。556例胎儿中,两项及两项以上软指标阳性胎儿不良妊娠结局的发生率为32.50%(13/40),明显高于一项软指标阳性胎儿的11.05%(57/516),差异有统计学意义(χ2=5.055,P<0.001);软指标阳性合并结构异常胎儿不良妊娠结局的发生率为80.77%(21/26),明显高于单纯软指标阳性胎儿的12.08%(64/530),差异有统计学意义(χ2=90.310,P<0.001)。二元Logistic回归结果表明脉络丛囊肿、单脐动脉、肠管回声增强、静脉导管a波缺失或倒置、鼻骨发育不良、NT增厚、心室点状增强回声与胎儿不良妊娠结局密切相关(均P<0.05),而三尖瓣反流、轻度肾窦分离与胎儿不良妊娠结局无明显相关性(均P>0.05)。结论早孕期超声软指标对于预测胎儿不良妊娠结局具有重要意义。对于多个软指标阳性或软指标阳性合并结构异常胎儿,尤其应提高警惕,需对其进行全面综合评估。

Objective To explore the relationship between soft markers found in the first trimester(11-13+6 gestational weeks)ultrasound screening and fetal adverse pregnancy outcomes.Methods Single pregnancy fetuses were selected from the Multicenter Clinical Study of First Trimester Screening in China during August 2017 to August 2020.The types and detection rate of soft markers during the first trimester were compared.The correlation between positive soft markers and adverse pregnancy outcomes was analyzed by binary Logistics regression.Results A total of 16625 fetuses with complete follow-up outcomes were included in the group.Six hundred and seven ultrasonic soft markers were detected in 556 fetuses with positive soft markers during the first trimester,and the first four most frequently occurred were increased nuchal translucency(NT)(2.08%,345/16625),echogenic intracardiac focus(EIF)(0.94%,156/16625),hypoplasia of fetal nasal bone(0.20%,34/16625),single umbilical artery(SUA)(0.19%,31/16625).Among 556 fetuses,the incidence of adverse pregnancy outcome in fetuses with two or more positive soft markers was 32.50%(13/40),which was significantly higher than fetuses with single positive soft marker(11.05%,57/516),and the difference was statistically significant(χ2=5.055,P<0.001).The incidence of adverse pregnancy outcome in positive soft markers fetus associated with structural abnormalities was 80.77%(21/26),which was significantly higher than fetuses with isolated positive soft marker(12.08%,64/530),and the difference was statistically significant(χ2=90.310,P<0.001).Binary logistic regression analysis showed choroid plexus cyst(CPC),SUA,echogenic bowel(EB),absent/reversed a-wave of ductus venosus,hypoplasia of fetal nasal bone,increased NT,and EIF were closely related to the adverse pregnancy outcomes(all P<0.05).However,there were no significant correlations between tricuspid regurgitation(TR),pyelectasis(PYE)and fetal adverse pregnancy outcomes(all P>0.05).Conclusions The ultrasonic soft markers during the first trimester are of great significance in predicting fetal adverse pregnancy outcomes.For multiple positive soft markers or positive soft markers combined with structural abnormalities,more attention should be paid to them and comprehensive evaluation is required to be carried out.