超声软指标筛查与诊断孕11～13+6周胎儿开放性脊柱裂的临床价值
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摘要
目的:探讨早孕期超声筛查胎儿开放性脊柱裂(open spine bifida,OSB)的方法,试图提早开放性脊柱裂诊断时间。材料与方法:选择300例正常胎儿按孕周分为11~11+6周、12~12+6周、13~13+6三组,每组100例,常规检查颈项透明层(NT)后,在此切面上测量胎儿颅内透明层(IT)厚度、脑干直径(BS)与脑干-枕骨间距离(BSOB),计算出BS/BSOB比值,并对测量值与比值进行统计,得出正常值范围。然后用测得的正常值,对3000例11~13+6孕周胎儿分别用IT、BS、BSOB和BS/BSOB进行OSB的诊断试验评价,并计算其特异性、敏感性、漏诊率、误诊率和Youden指数。结果:300例11~13+6孕周胎儿的正常参考值范围分别为:IT 1.3-2.3mm,BS 1.8-3.4mm,BSOB 3.0-5.8mm,BS/BSOB比值0.5-0.8。在诊断试验评价的3000例胎儿中经引产或新生儿随访证实为OSB共5例,用IT、BS、BSOB和BS/BSOB异常筛查OSB的情况为:IT 3/5例,BS 1/5例,BSOB 2/5例,BS/BSOB比值4/5例,其敏感性和特异性分别为60%/99.4%;20%/99.3%;40%/99.5%;80%/99.8%。结论:BS/BSOB比值>1.0是筛查早孕期胎儿OSB较敏感的指标。
Purpose:To investigate the method of early pregnancy ultrasound screening for fetal open spina bifida(open spine bifida,OSB),and trying to advance the time of open spina bifida diagnosis.Materials and Methods:300 cases of normal fetuses was divided into 11 to 11 + 6 weeks,12 to 12 + 6 weeks,13 to 13 + 6 three groups according to gestational age,each group after 100 cases,given the routine examination nuchal translucency(NT),in fetal intracranial transparent layer(IT) measuring the thickness of this section,the diameter of the brainstem(BS) and the brainstem-the distance between the occipital(BSOB),calculated BS/BSOB ratio,and the ratio of the measured value statistics,drawn normal value range.Then measured the normal value of 3000 cases of 11 to 13 + 6 weeks of gestation fetuses were used IT,BS,BSOB and BS/BSOB conduct diagnostic tests evaluated OSB,and calculate their specificity,sensitivity,rate of misdiagnosis,misdiagnosis rate and Youden index.Results:In 300 cases of 11 to 13 + 6 weeks of gestation the fetus,the normal reference range are:IT 1.3-2.3mm,BS 1.8-3.4mm,BSOB 3.0-5.8mm,BS/BSOB ratio of 0.5-0.8.In diagnostic tests evaluated3000 fetuses by abortion or neonatal follow-up confirmed 5 cases of OSB,with IT,BS,BSOB and BS/BSOB abnormal screening OSB's case:IT 3/5 cases,BS 1/5 Example,BSOB 2/5 cases,BS/BSOB ratio 4/5 cases,the sensitivity and specificity were 60%/99.4%; 20%/99.3%; 40%/99.5%; 80%/99.8%.Conclusion:From the study we can see that the ratio of BS/BSOB > 1.0 is more sensitive to the fetus during early pregnancy screening OSB indicators.
Purpose:To investigate the method of early pregnancy ultrasound screening for fetal open spina bifida(open spine bifida,OSB),and trying to advance the time of open spina bifida diagnosis.Materials and Methods:300 cases of normal fetuses was divided into 11 to 11 + 6 weeks,12 to 12 + 6 weeks,13 to 13 + 6 three groups according to gestational age,each group after 100 cases,given the routine examination nuchal translucency(NT),in fetal intracranial transparent layer(IT) measuring the thickness of this section,the diameter of the brainstem(BS) and the brainstem-the distance between the occipital(BSOB),calculated BS/BSOB ratio,and the ratio of the measured value statistics,drawn normal value range.Then measured the normal value of 3000 cases of 11 to 13 + 6 weeks of gestation fetuses were used IT,BS,BSOB and BS/BSOB conduct diagnostic tests evaluated OSB,and calculate their specificity,sensitivity,rate of misdiagnosis,misdiagnosis rate and Youden index.Results:In 300 cases of 11 to 13 + 6 weeks of gestation the fetus,the normal reference range are:IT 1.3-2.3mm,BS 1.8-3.4mm,BSOB 3.0-5.8mm,BS/BSOB ratio of 0.5-0.8.In diagnostic tests evaluated3000 fetuses by abortion or neonatal follow-up confirmed 5 cases of OSB,with IT,BS,BSOB and BS/BSOB abnormal screening OSB's case:IT 3/5 cases,BS 1/5 Example,BSOB 2/5 cases,BS/BSOB ratio 4/5 cases,the sensitivity and specificity were 60%/99.4%; 20%/99.3%; 40%/99.5%; 80%/99.8%.Conclusion:From the study we can see that the ratio of BS/BSOB > 1.0 is more sensitive to the fetus during early pregnancy screening OSB indicators.
引文
1胡亚美,江载芳,诸福堂。实用儿科学[M]7版北京:人民卫生出版社2002 1900-1901。
2 、5秦风真,李胜利。孕11~13+6周胎儿开放性脊柱裂产前筛查与诊断研究进展[J/CD]中华医学超声杂志(电子版):2014,11(1):9-13。
3 Chaoui R,Benoit B,Mitkowska-Wozniak H,et al.Assessment of intracranial translucency(IT)in the detection of spina bifida at the 11-13-week scan.Ultrasoud obstet Gynecol,2009,34(3):249-252.
4 Chaoui R,Nicolaides KH.From nuchal translucency to intracranial translucency:towards the early detection of spina bifida.Ultrasound Obestet Gynecol,2010,35(2):133-138.
6 秦风真,李胜利,文华轩,等。11~13+6周胎儿颅后窝结构的产前超声检测[J]。J South Med Univ,2014,34(7):950-955。
7 周富强,蔡莹莹,刘宇清,等。超声对孕11~13+6周胎儿颅内透明层检查声像研究[J]。中国医学工程,2016,24(2):37-38。
8 郭海欣,吕国荣,陈少华,等。超声检测中孕早期胎儿开放性脊柱裂的指标及其意义[J]。中国超声医学杂志,2014,30(11):1014-1016。
9 张玉娟,林琪,李剑,等。11~13+6孕周胎儿颅内透明层及后脑结构与开放性脊柱裂相关研究[J]。中国超声医学杂志,2015,31(9):851-852。
2 、5秦风真,李胜利。孕11~13+6周胎儿开放性脊柱裂产前筛查与诊断研究进展[J/CD]中华医学超声杂志(电子版):2014,11(1):9-13。
3 Chaoui R,Benoit B,Mitkowska-Wozniak H,et al.Assessment of intracranial translucency(IT)in the detection of spina bifida at the 11-13-week scan.Ultrasoud obstet Gynecol,2009,34(3):249-252.
4 Chaoui R,Nicolaides KH.From nuchal translucency to intracranial translucency:towards the early detection of spina bifida.Ultrasound Obestet Gynecol,2010,35(2):133-138.
6 秦风真,李胜利,文华轩,等。11~13+6周胎儿颅后窝结构的产前超声检测[J]。J South Med Univ,2014,34(7):950-955。
7 周富强,蔡莹莹,刘宇清,等。超声对孕11~13+6周胎儿颅内透明层检查声像研究[J]。中国医学工程,2016,24(2):37-38。
8 郭海欣,吕国荣,陈少华,等。超声检测中孕早期胎儿开放性脊柱裂的指标及其意义[J]。中国超声医学杂志,2014,30(11):1014-1016。
9 张玉娟,林琪,李剑,等。11~13+6孕周胎儿颅内透明层及后脑结构与开放性脊柱裂相关研究[J]。中国超声医学杂志,2015,31(9):851-852。