目的 分析颈部透明层(NT)增厚胎儿中,影响水囊状淋巴管瘤(CH)胎儿预后的相关因素.方法 收集2014年1月至2015年12月于首都医科大学附属北京妇产医院因孕11周～13周+6超声检查提示NT≥3.0 mm、接受侵入性产前诊断的胎儿216例,将资料完整、定期产前检查随访的164例(75.9％)单胎胎儿纳入研究.根据胎儿是否存在CH,分为CH组40例(24.4％)和单纯NT增厚组124例(75.6％),比较两组胎儿发生染色体核型异常、重要器官结构畸形、不良妊娠结局的情况.采用logistic回归分析,分析CH是否分隔、NT值对CH胎儿的染色体核型、重要器官结构和妊娠结局的影响.结果 (1)CH组与单纯NT增厚组胎儿染色体核型异常[分别为55.0％(22/40)、29.0％(36/124)]、重要器官结构畸形[分别为45.0％(18/40)、25.8％(32/124)]、不良妊娠结局[分别为92.5％(37/40)、50.8％(63/124)]的发生率,分别比较,差异均有统计学意义(P均<0.05).(2)CH组胎儿的NT值明显大于单纯NT增厚组(中位数分别为8.32、5.06 mm,P<0.01).(3)logistic回归分析发现,NT值是影响CH胎儿预后的重要风险因素,NT值每增加1.0 mm胎儿染色体核型异常、重要器官结构畸形及不良妊娠结局的发生风险分别增加1.171、1.192、1.913倍(P均<0.05);而CH是否存在分隔,不增加胎儿染色体核型异常、重要器官结构畸形、不良妊娠结局的风险(P均>0.05).结论 妊娠早期颈部CH胎儿预后不佳,NT值严重增厚是影响CH胎儿不良预后的重要因素;而CH分隔的出现,并不增加不良妊娠结局的风险.%Objective To analyze prognosis-related risk factors of first trimester cystic hygroma (CH)fetuses in which nuchal translucency(NT)was found to be thickened. Methods Tolly 216 singleton pregnancies in which fetal NT≥3.0 mm at the 11～13+6 weeks scan accepted invasive prenatal diagnosis in Beijing Gynecology and Obstetrics Hospital, Capital Medical University, from January 2014 to December 2015 were collected. A total of 164(75.9％, 164/216)single fetuses with complete data were included, they were classified into two groups, namely'CH'and'increased NT'which without CH. And 40 pregnancies (24.4％, 40/164)presented with CH group, 124 pregnancies(75.6％, 124/164)were with increased NT group. The chromosome karyotype abnormality, major organ structure malformation and adverse outcome were compared between the two groups. Logistic regression analysis was used to investigate the effect of increased NT thickness, the presence of septa in CH on abnormal karyotype, major congenital anomaly and adverse outcome. Results (1)The incidence of fetal abnormal karyotype [55.0％(22/40)vs 29.0％(36/124)], major organ anomalies [45.0％(18/40)vs 25.8％(32/124)], and adverse outcome [92.5％(37/40)vs 50.8％(63 / 124)] were significantly different(all P<0.05)between the CH group and the increased NT group.(2)NT measurement was significantly higher in the CH group than that in the increased NT group (8.32 vs 5.06 mm, P<0.01).(3)Logistic analysis revealed that NT thickness was the significant risk factor in the prediction of adverse outcome for CH fetuses in first trimester. The risks of chromosomal defect, major congenital anomaly and adverse outcome increased 1.171, 1.192 and 1.913-fold(all P<0.05)with 1.0 mm increased NT thickness, while the presence of septa in CH didn't increase the risks of above(all P>0.05). Conclusions The perinatal outcome of CH is poor. The poor outcome of CH is closely attributed to thickened NT, and the presence of septa in CH does not increase the risk of adverse outcome for CH fetuses.
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