颈项透明层厚度检测联合孕中期的四维彩超检测在胎儿畸形诊断中的参考价值分析
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摘要
目的分析颈项透明层厚度检测联合孕中期的四维彩超检测在胎儿畸形诊断中的参考价值。方法选取2016年6月至2018年8月于我院行胎儿畸形筛查的1952位孕妇为研究对象,所有研究对象均接受了胎儿的颈项透明层的厚度的超声检测和孕中期四维彩超的检测,分析各检测方法的筛查结果,并对产后结果进行随访追踪。结果胎儿颈项透明层厚度的超声检测出27例畸形胎儿,后随访确诊30例,漏诊率为10%;孕中期四维彩超胎儿畸形检测提示29例胎儿,后随访确诊31例,漏诊率为6.4%;颈项透明层厚度超声检测、四维超声以及联合检测的AOC曲线下面积分别为0.68、0.71、0.83,联合检测的诊断敏感性显著高于单独的颈项透明层厚度超声检测和四维超声检测(P均>0.05)。结论颈项透明层厚度检测联合孕中期的四维彩超检测在胎儿畸形诊断中具有较好的参考价值,临床上应结合实际情况使用。
Objective:To analyze the reference value of four-dimensional color Doppler ultrasound detection in the diagnosis of fetal malformation with detection of cervical transparent layer thickness. Methods:A total of 1952 pregnant women who underwent fetal malformation screening from August 2016 to August 2018 were enrolled. All subjects underwent ultrasound examination of the thickness of the cervical transparent layer of the fetus and the fourth trimester of the second trimester. The screening results of each test method were analyzed,and the postpartum results were followed up. Results:Twenty-seven cases of malformed fetuses were detected by ultrasonography,and 30 cases were diagnosed by follow-up. The missed diagnosis rate was 10%. In the second trimester,the four-dimensional color Doppler fetal malformation test showed 29 cases of fetuses,and 31 cases were confirmed by follow-up. The rate of missed diagnosis was 6.4%. The area under the AOC curve of the transparent layer thickness of the cervical transparent layer,the four-dimensional ultrasound and the combined detection were 0.68,0.71,and0.83,respectively. The diagnostic sensitivity of the combined detection was significantly higher than that of the separate cervical transparent layer thickness ultrasonic testing and four-dimensional ultrasonic testing(P>0.05). Conclusion:The detection of neck transparent layer thickness combined with the four-dimensional color Doppler ultrasound detection in the second trimester has a good reference value in the diagnosis of fetal malformation. It should be used clinically in combination with the actual situation.
Objective:To analyze the reference value of four-dimensional color Doppler ultrasound detection in the diagnosis of fetal malformation with detection of cervical transparent layer thickness. Methods:A total of 1952 pregnant women who underwent fetal malformation screening from August 2016 to August 2018 were enrolled. All subjects underwent ultrasound examination of the thickness of the cervical transparent layer of the fetus and the fourth trimester of the second trimester. The screening results of each test method were analyzed,and the postpartum results were followed up. Results:Twenty-seven cases of malformed fetuses were detected by ultrasonography,and 30 cases were diagnosed by follow-up. The missed diagnosis rate was 10%. In the second trimester,the four-dimensional color Doppler fetal malformation test showed 29 cases of fetuses,and 31 cases were confirmed by follow-up. The rate of missed diagnosis was 6.4%. The area under the AOC curve of the transparent layer thickness of the cervical transparent layer,the four-dimensional ultrasound and the combined detection were 0.68,0.71,and0.83,respectively. The diagnostic sensitivity of the combined detection was significantly higher than that of the separate cervical transparent layer thickness ultrasonic testing and four-dimensional ultrasonic testing(P>0.05). Conclusion:The detection of neck transparent layer thickness combined with the four-dimensional color Doppler ultrasound detection in the second trimester has a good reference value in the diagnosis of fetal malformation. It should be used clinically in combination with the actual situation.
引文
[1]杨正春,冉素真,谭丽芳,等.胎儿畸形的临床分析[J].中国介入影像与治疗学,2016,13(10):632-635.
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[5]蒋瑜,杨太珠,罗红.128例颈项透明层厚度异常染色体正常胎儿妊娠结局分析[J].中国超声医学杂志,2017,15(5):447-449.
[6]华方明,任苓,曾庆新,等.早孕期胎儿中枢神经系统畸形的超声影像诊断[J].中华超声影像学杂志,2017,26(5):11-19.
[7]朱丽红,王新春.168例胎儿先天畸形的临床分析及干预措施[J].中华现代护理杂志,2013,19(13):1548-1551.
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[11]阮飞娜.四维彩超联合胎儿NT超声检测诊断胎儿畸形的价值[J].包头医学院学报,2018,16(6):23-24.
[12]Aboellail M A,Ishimura M,Sajapala S,et al.Three-Dimensional Color/Power Doppler Sonography and HDlive Silhouette Mode for Diagnosis of Molar Pregnancy.[J].Journal of Ultrasound in Medicine,2016,35(9):204-216.
[13]刘丽华,卢小青,刘聪慧,等.胎儿颈项透明层厚度联合血清学检测在唐氏综合征筛查中的应用[J].中国妇幼保健,2013,28(17):2715-2717.
[14]Aboellail M A,Kanenishi K,Tenkumo C,et al.Four-Dimensional Power Doppler Sonography With the HDlive Silhouette Mode in Antenatal Diagnosis of a Right Aortic Arch With an Aberrant Left Subclavian Artery.[J].Journal of Ultrasound in Medicine,2016,35(3):661-669.
[15]周紫玲.四维彩超对胎儿畸形的诊断价值分析[J].临床医学研究与实践,2017,2(16):142-143.
[16]朱环.分析四维彩超在诊断胎儿畸形中的应用价值[J].中国医药指南,2016,14(16):118-118.
[17]Chaoui R,Hoffmann JHeling K S.Three-dimensional(3D)and4D color Doppler fetal echocardiography using spatio-temporal image correlation(STIC).[J].Ultrasound in Obstetrics&Gynecology,2010,23(6):535-545.
[18]谭冰.胎儿颈项透明层厚度超声检测联合孕中期四维彩超诊断胎儿畸形的应用价值[J].现代医用影像学,2017,26(4):957-959.
[19]张艳荣.采用四维彩色多普勒超声研究胎教存在的客观性[J].重庆医学,2011,40(9):878-880.
[20]朱继红,陈英红,文珂,等.超声测量胎儿颈项透明层厚度与孕中期母体血清学检测筛查唐氏综合征[J].重庆医学,2015,44(17):2381-2383.
[21]寇世和,任秀珍,王凤兰,等.产前超声检查诊断胎儿畸形的价值分析[J].中国妇幼保健,2012,27(1):103-105.
[22]Shen O,Yagel S.The added value of 3D/4D ultrasound imaging in fetal cardiology:has the promise been fulfilled?[J].Ultrasound in Obstetrics&Gynecology the Official Journal of the International Society of Ultrasound in Obstetrics&Gynecology,2010,35(3):260-272.
[2]马小卿,苏向珍,李连香,等.产前超声筛查胎儿畸形的临床分析[J].中国妇幼保健,2014,29(2):301-303.
[3]赵宝珍,刘云,刘艳明,等.二维超声联合四维超声对不同孕周产前超声筛查胎儿畸形的临床分析[J].中国保健营养,2016,26(12).
[4]Aboellail M A,Kanenishi K,Tenkumo C,et al.Diagnosis of truncus arteriosus in first trimester of pregnancy using transvaginal four-dimensional color Doppler ultrasound.[J].Ultrasound in Obstetrics&Gynecology,2015,45(6):759-760.
[5]蒋瑜,杨太珠,罗红.128例颈项透明层厚度异常染色体正常胎儿妊娠结局分析[J].中国超声医学杂志,2017,15(5):447-449.
[6]华方明,任苓,曾庆新,等.早孕期胎儿中枢神经系统畸形的超声影像诊断[J].中华超声影像学杂志,2017,26(5):11-19.
[7]朱丽红,王新春.168例胎儿先天畸形的临床分析及干预措施[J].中华现代护理杂志,2013,19(13):1548-1551.
[8]Arts H,Van E J.Antenatal diagnosis of vasa previa by transvaginal color Doppler sonography.[J].Ultrasound in Obstetrics&Gynecology,2010,3(4):276-278.
[9]Kanda E,Matsuda Y,Kamitomo M,et al.Prenatal diagnosis and management of vasa previa:a 6-year review.[J].Journal of Obstetrics&Gynaecology Research,2011,37(10):1391-1396.
[10]黄秋媚,曾静,何敏,等.胎儿颈项透明层厚度超声检测联合孕中期四维彩超诊断胎儿畸形的应用价值[J].当代医学,2014,14(5):20-21.
[11]阮飞娜.四维彩超联合胎儿NT超声检测诊断胎儿畸形的价值[J].包头医学院学报,2018,16(6):23-24.
[12]Aboellail M A,Ishimura M,Sajapala S,et al.Three-Dimensional Color/Power Doppler Sonography and HDlive Silhouette Mode for Diagnosis of Molar Pregnancy.[J].Journal of Ultrasound in Medicine,2016,35(9):204-216.
[13]刘丽华,卢小青,刘聪慧,等.胎儿颈项透明层厚度联合血清学检测在唐氏综合征筛查中的应用[J].中国妇幼保健,2013,28(17):2715-2717.
[14]Aboellail M A,Kanenishi K,Tenkumo C,et al.Four-Dimensional Power Doppler Sonography With the HDlive Silhouette Mode in Antenatal Diagnosis of a Right Aortic Arch With an Aberrant Left Subclavian Artery.[J].Journal of Ultrasound in Medicine,2016,35(3):661-669.
[15]周紫玲.四维彩超对胎儿畸形的诊断价值分析[J].临床医学研究与实践,2017,2(16):142-143.
[16]朱环.分析四维彩超在诊断胎儿畸形中的应用价值[J].中国医药指南,2016,14(16):118-118.
[17]Chaoui R,Hoffmann JHeling K S.Three-dimensional(3D)and4D color Doppler fetal echocardiography using spatio-temporal image correlation(STIC).[J].Ultrasound in Obstetrics&Gynecology,2010,23(6):535-545.
[18]谭冰.胎儿颈项透明层厚度超声检测联合孕中期四维彩超诊断胎儿畸形的应用价值[J].现代医用影像学,2017,26(4):957-959.
[19]张艳荣.采用四维彩色多普勒超声研究胎教存在的客观性[J].重庆医学,2011,40(9):878-880.
[20]朱继红,陈英红,文珂,等.超声测量胎儿颈项透明层厚度与孕中期母体血清学检测筛查唐氏综合征[J].重庆医学,2015,44(17):2381-2383.
[21]寇世和,任秀珍,王凤兰,等.产前超声检查诊断胎儿畸形的价值分析[J].中国妇幼保健,2012,27(1):103-105.
[22]Shen O,Yagel S.The added value of 3D/4D ultrasound imaging in fetal cardiology:has the promise been fulfilled?[J].Ultrasound in Obstetrics&Gynecology the Official Journal of the International Society of Ultrasound in Obstetrics&Gynecology,2010,35(3):260-272.