妊娠期甲状腺功能减退对胎儿脑部发育影响的超声 研究

Ultrasonographic assessment of the brain development of fetuses of maternal hypothyroidism in pregnancy

目的:探讨超声在评价妊娠期母体甲状腺功能减退(HDP)胎儿脑部发育情况中的临床应用价值。方法:选取产前超声检查、孕周为21~30+6周的HDP胎儿作为病例组(n=209);正常胎儿作为对照组(n=908)。前瞻性测量所有胎儿额叶横径(TFLD)、小脑横径(TCD)、双顶径(BPD)、头围(HC)、大脑中动脉(MCA)血流参数,计算TCD/TFLD;按照超声简化分级法将大脑外侧裂(SF)发育程度分成0~5等级:0级(直线形),1级(浅弧形),2级(钝角平台形),3级(直角平台形),4级(锐角平台形),5级(“工”字形),记录所有胎儿SF形态等级。分析对照组TFLD、TCD、TCD/TFLD与孕周的相关性;比较两组间各参数及SF等级的差异。结果:对照组TFLD、TCD与孕周正相关(TFLD:R^(2)=0.928,P<0.05;TCD:R^(2)=0.919,P<0.05),TCD/TFLD与孕周正相关(R^(2)=0.517,P<0.05)。病例组TFLD、TCD、BPD、HC、MCA-PSV较对照组减小,TCD/TFLD、MCA-S/D、MCA-RI较对照组增大,病例组SF发育等级偏低,差异均有统计学意义(P<0.05)。两组MCA-PI比较,差异无统计学意义(P>0.05)。结论:结论:HDP胎儿脑部超声二维径线减小,对额叶及小脑均有影响,MCA流速降低、阻力增加,SF发育延迟。

Objective:To investigate the clinical value of ultrasound in the evaluation of fetal brain development in hypothyroidism in pregnancy(HDP).Methods:A total of 209 HDP fetuses with prenatal ultrasound examination and gestational weeks of 21~30+6 weeks were selected as the case group and 908 normal fetuses as the control group.The transverse frontal lobe diameter(TFLD),transverse cerebellar diameter(TCD),biparietal diameter(BPD),head circumference(HC),and middle cerebral artery(MCA)blood flow parameters were prospectively measured in all fetuses,and TCD/TFLD was calculated.The degree of the development of the sylvian fissure of the brain(SF)was categorized into grades 0~5 according to the simplified ultrasound grading method:grade 0(rectilinear),grade 1(shallow arcuate),grade 2(obtuse angle plateau),grade 3(right-angle platform shape),grade 4(acute-angle platform shape),and grade 5(“I”shaped),and all fetal SF morphology grades were recorded.The correlation between TFLD,TCD,TCD/TFLD and gestational week in the control group were analyzed.The differences of each parameter and SF grade were compared between the two groups.Results:In the control group,TFLD and TCD were positively correlated with gestational weeks(TFLD:R^(2)=0.928,P<0.05,TCD:R^(2)=0.919,P<0.05),and TCD/TFLD was positively correlated with gestational weeks(R^(2)=0.517,P<0.05).TFLD,TCD,BPD,HC,and MCA-PSV were reduced in the case group compared with the control group,TCD/TFLD,MCA-S/D,and MCA-RI were increased compared with the control group,and SF developmental grade was lower in the case group,and the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups of MCA-PI(P>0.05).Conclusion:HDP fetal brain ultrasound 2D radial reduction,it has an impact on both the frontal lobe and cerebellum,with reduced MCA flow rate,increased resistance,and delayed SF development.