超声检查与母体血清学联合检测筛查胎儿先天性心脏病

Ultrasound indexes and maternal serological detection for screening of fetal congenital heart diseases

摘要:

探讨于孕早期颈项透明层厚度（NT）、三尖瓣反流（TR）与动脉导管（DV）和孕中期母体血清甲胎蛋白（AFP）、游离β绒毛膜促性腺激素（free-β-HCG）检测在筛查胎儿先天性心脏病（CHD）中的意义和作用。方法对2010 年12 月-2016 年2 月于该院就诊的单胎孕妇共2 632 例，于孕11～14 周时进行产前诊断时行超声检查，3 项超声检查均异常视为高危；所有孕妇亦于孕15～21 周进行母血清标志物AFP 和free-β-HCG 测定，风险率≥1/270 为血清学筛查高危。并对所有孕妇进行随访。对超声检查高危、血清学筛查高危与两者联合筛查均高危结果进行比较。结果分别比较超声检查、血清学检测2 种检测结果，差异无统计学意义；联合筛查与超声检查、血清学检测结果比较，差异有统计学意义（p <0.05）。结论胎儿NT、TR、DV及母体血清学检测异常提示胎儿存在潜在的CHD的风险，超声检查联合血清学检查能提高CHD的检出率。

Abstract:

To discuss the value of the measurement of nuchal translucency (NT) thickness, tricuspid regurgitation (TR) and ductus venosus (DV) doppler waveform by ultrasonic testing at early pregnancy and maternal serum alpha -fetoprotein (AFP) and free β-human chorionic gonadotropin (free -β-HCG) at mid -pregnancy in screening of fetal congenital heart diseases (CHD). Methods A total of 2,632 pregnant women from December 2010 to February 2016 were selected. In 11-14 weeks of pregnancy, a combination of NT ≧3 mm, TR and abnormal blood flow waveform of DV was considered as high-risk signs. The levels of maternal serum AFP and free-β-HCG were detected during 15-21 gestational weeks. The risk was assessed by the software of analysis system, and the risk rate ≧1/270 was designed as high risk. Results The result of combined detection in screening of fetal CHD was significantly different from that of ultrasound examination or maternal serological detection (p < 0.05). Conclusions Fetal NT, TR, DV and maternal serological abnormalities suggest a potential risk of fetal CHD, and the combination of ultrasound examination and maternal serological detection can increase the detection rate of CHD.