孕早期NT增厚与DV异常筛查胎儿复杂先天性心脏畸形分析

Analysis of NT thickening and DV abnormality in early pregnancy for screening fetal complex congenital heart malformation

目的探究颈部透明层与静脉导管频谱在对孕早期胎儿复杂先天性心脏畸形中的筛查价值.方法选取2019年1月—2022年1月来我院进行产检的1781例孕妇作为本次的研究对象,所有的孕妇都进行静脉导管多普勒血流频谱与颈部透明层厚度检查,分析孕妇和胎儿的情况,静脉导管多普勒血流频谱与颈部透明层筛查结果,诊断效能,探究静脉导管多普勒血流频谱、颈部透明层和胎儿心脏畸形的关系.结果参加筛查的1781例孕妇中,共检出72例静脉导管多普勒血流频谱出现异常的胎儿,静脉导管筛查阳性率为4.04%(72/1781);51例胎儿颈项透明层厚度增厚,筛查阳性率为2.86%(51/1781);胎儿静脉导管和颈项透明层厚度均异常者24例,阳性率为1.35%(24/1781).与静脉导管和颈项透明层厚度均正常的胎儿比较,静脉导管和颈项透明层厚度均异常胎儿的先天性心脏畸形发生率显著升高(χ^(2)=8.664,P<0.01).分别与单一静脉导管异常(χ^(2)=9.174,P<0.01)和单一颈项透明层厚度异常(χ^(2)=10.214,P<0.01)的患者比较,两项指标联合筛查具有更高的筛查效率.早孕期静脉导管和颈项透明层厚度均异常对先天性心脏畸形的敏感性、特异性分别为42.42%(14/33)、99.42%(1738/1748).结论静脉导管和颈部透明层两项指标联合筛查相对于单一静脉导管或颈部透明层指标来说,虽然敏感性降低了,但明显提高了阳性预测值和特异性,说明其具有更高的筛查效率.

Objective To explore the value of cervical transparent layer and venous catheter spectrum in screening fetal complex congenital heart malformations in early pregnancy.Methods In January 2019-January 2022 to our hospital for prenatal 1781 cases of pregnant women as the object of study,all pregnant women with intravenous catheter doppler blood flow spectrum and neck transparent layer thickness inspection,analysis the situation of the fetus,venous catheter doppler blood flow spectrum and the neck as a result,the transparent layer screening diagnosis efficiency,To explore the relationship between venous catheter Doppler flow spectrum,cervical transparent layer and fetal heart malformation.Results Among 1781 pregnant women participating in the screening,72 fetuses with abnormal Doppler blood flow spectrum of venous catheter were detected,and the positive rate of venous catheter screening was 4.04%(72/1781).The thickness of the nuchal translucency of 51 fetuses was thickened,and the positive rate of screening was 2.86%(51/1781).There were 24 cases with abnormal thickness of fetal venous catheter and nuchal translucency,the positive rate was 1.35%(24/1781).Compared with fetuses with normal thickness of venous catheter and nuchal translucency,the incidence of congenital heart malformation in fetuses with abnormal thickness of venous catheter and nuchal translucency was significantly higher(x^(2)=8.664,P<0.01).Respectively and single venous catheter abnormality(x^(2)=9.174,P<0.01)and abnormal thickness of single nuchal transparent layer(x^(2)=10.214,P<0.01).The sensitivity and specificity of abnormal thickness of venous catheter and nuchal pellucid layer in early pregnancy to congenital heart malformation were 42.42%(14/33)and 99.42%(1738/1748)respectively.Conclusion Compared with single venous catheter or cervical transparent layer,the combined screening of the two indicators decreased sensitivity,but significantly improved the positive predictive value and specificity,indicating that it has a higher screening efficiency.