孕11～13＋6周胎儿静脉导管搏动指数与肝动脉搏动指数在唐氏筛查中的应用价值

摘要

目的：评价孕11～13＋6周胎儿静脉导管搏动指数（DV－PIV）与肝动脉搏动指数（HA－PI）在唐氏早孕期联合筛查高风险孕妇中的应用价值。方法收集早孕期唐氏筛查高风险且颈项透明层（ NT）测量值正常的单胎孕妇223例作为观察组，同时收集早孕期唐氏筛查低风险、NT测量值正常且与观察组年龄、孕周相似的孕妇252例作为对照组，比较两组间胎儿DV－PIV和HA－PI的差异，比较观察组唐氏胎儿与对照组胎儿DV－PIV和HA－PI的差异，并采用受试者特征曲线（ ROC曲线）分析DV－PIV和HA－PI诊断21三体的价值。结果观察组胎儿DV－PIV显著高于对照组（P＜0.05），而两组胎儿HA－PI差异无统计学意义（P＞0.05）；观察组唐氏胎儿DV－PIV显著高于对照组胎儿（P＜0.05），而HA－PI显著低于对照组胎儿（P＜0.05）。 ROC曲线显示，DV－PIV（截断值为2.1）用于预测21三体的敏感性为86.1％，特异性为96.2％；HA－PI（截断值为1.0）用于诊断21三体的敏感性为70.9％，特异性为94.1％。结论早孕期唐氏筛查中增加DV－PIV和HA－PI的检测可提高唐氏综合征筛查的准确性。%Objective To evaluate the applications of fatal ductus venosus pulsatility index of vein ( DV-PIV) and hepatic artery pulsatility index ( HA-PI) in Down syndrome screening for pregnant women at 11 -13 +6 weeks. Methods 223 women with singleton pregnancy with high risk for aneuploidy in combined screening test and normal nu-chal translucency ( NT) measurements were included as study group, and 252 women with similar age, gestational age, normal NT measurements and low-risk in first trimester combined tests were enrolled as control group.Fatal DV-PIV and HA-PI were compared between the two groups, while DV-PIV and HA-PI were compared between fetuses with Down syndrome in study group and fetuses in control group.Receiver operating characteristics ( ROC) curves were used to evaluate the capacities of fatal DV-PIV and HA-PI in the diagnosis of trisomy 21.Results Fatal DV-PIV was signif-icantly higher in study group ( P<0.05 ) , whereas no significant difference was revealed in fatal HA-PI ( P>0.05 ) . DV-PIV was significantly higher but HA-PI was significantly lower of fetuses with Down syndrome in study group when comparing with fetuses in control group (P<0.05).The sensitivity and specificity of DV-PIV in the diagnosis of trisomy 21, with the cutoff of 2.1, were 86.1%and 96.2%, respectively.The sensitivity and specificity of HA-PI in the diagno-sis of trisomy 21, with the cutoff of 1.0, were 70.9%and 94.1%, respectively.Conclusion The addition of DV-PIV and HA-PI measurements during the first trimester of pregnancy increases the accuracy for Down syndrome detection.