妊娠早期超声胎儿颈项透明层厚度对胎儿畸形及胎儿健康状况的诊断价值

Value of nuchal translucency in diagnosing fetal malformation and predicting fetal health during early pregnancy

摘要:

目的 探讨妊娠早期超声胎儿颈项透明层厚度（NT）对胎儿畸形及胎儿健康状况的诊断价值。方法 选取2019年1月—2022年10月三亚市妇幼保健院经超声诊断的胎儿NT增厚的孕妇210例，比较有无器官结构畸形、有无染色体核型异常的胎儿的NT厚度的差异，比较正常分娩存活与不良妊娠结局胎儿NT厚度的差异。结果 210例孕妇中，最终诊断胎儿器官结构畸形87例（41.43%），其中多处畸形者50例；胎儿染色体核型异常68例（32.38%）。有胎儿器官结构畸形组NT厚度高于无胎儿器官结构畸形组（P <0.05）。有染色体核型异常组NT厚度高于无染色体核型异常组（P <0.05）。胎儿NT厚度诊断器官结构畸形的受试者工作特征（ROC）曲线结果显示，曲线下面积为0.879（95% CI：0.832，0.927），截断值为4.21 mm，敏感性性和特异性分别为88.50%（95% CI：0.810，0.930）和75.60%（95% CI：0.700，0.805）；胎儿NT厚度诊断染色体核型异常的ROC曲线下面积为0.840（95% CI：0.785，0.896），截断值为4.30 mm，敏感性和特异性分别为88.20%（95% CI：0.803，0.940）和66.90%（95% CI：0.603，0.760）。正常分娩存活胎儿NT厚度低于不良妊娠结局胎儿（P <0.05）。胎儿NT厚度诊断不良妊娠结局的ROC曲线结果显示，曲线下面积为0.833（95% CI：0.780，0.887），截断值为4.52 mm，敏感性和特异性分别为66.30%（95% CI：0.610，0.723）和84.30%（95% CI：0.760，0.910）。结论 妊娠早期超声胎儿NT在诊断胎儿器官结构畸形、染色体核型异常以及不良妊娠结局方面有较好的应用价值，值得进一步研究。

Abstract:

Objective To explore the value of nuchal translucency (NT) in the diagnosis of fetal malformation and the prediction of fetal health during early pregnancy.Methods The 210 pregnant women with a thickened fetal NT in Sanya Maternal and Child Health Hospital from January 2019 to October 2022 were selected. The fetal NT thickness was compared between fetuses with and without structural abnormalities and chromosomal abnormalities, and between those with normal delivery and adverse pregnancy outcomes.Results Among 210 pregnant women, 87 cases (41.43%) were finally diagnosed with structural abnormalities, of which 50 cases had multiple structural abnormalities. Sixty-eight cases (32.38%) were diagnosed as chromosomal abnormalities. The fetal NT thickness of pregnant women with fetal structural abnormalities was higher than that of pregnant women without structural abnormalities (P < 0.05). The fetal NT thickness of pregnant women with fetal chromosomal abnormalities was higher than that of pregnant women without chromosomal abnormalities (P < 0.05). The receiver operating characteristic (ROC) curve analysis revealed that the area under the ROC curve of fetal NT thickness for diagnosing fetal structural abnormalities was 0.879 (95% CI: 0.832, 0.927) with a cutoff value of 4.21 mm, and the sensitivity and specificity were 88.50% (95% CI: 0.810, 0.930) and 75.60% (95% CI: 0.700, 0.805), respectively. The area under the ROC curve of fetal NT thickness for diagnosing fetal chromosomal abnormalities was 0.840 (95% CI: 0.785, 0.896) with a cutoff value of 4.30 mm, and the sensitivity and specificity were 88.20% (95% CI: 0.803, 0.940) and 66.90% (95% CI:0.603, 0.760), respectively. The fetal NT thickness in those with normal delivery was lower than that in those with adverse pregnancy outcomes (P < 0.05). The area under the ROC curve of fetal NT thickness for predicting adverse pregnancy outcomes was 0.833 (95% CI: 0.780-0.887) with a cutoff value of 4.52 mm, and the sensitivity and specificity were 66.30% (95% CI: 0.610, 0.723) and 84.30% (95% CI: 0.760, 0.910), respectively.Conclusion NT is of great value in predicting fetal structural and chromosomal abnormalities and adverse pregnancy outcomes, which warrants further study.