孕早期胎儿颈项透明层厚度联合静脉导管频谱对先天性心脏畸形的预测价值

摘要

Objective To investigate the clinical application value of increased nuchal translucency (NT) thick-ness and abnormal blood flow spectrum of ductus venosus (DV) in predicting congenital heart disease (CHD) in early pregnancy. Methods From January 2012 to June 2015, fetal regular DV and NT measurements were performed on 1 996 pregnant women within 11~13+6 gestational weeks. The fetuses were followed up, and the relationship between DV, NT and CHD was analyzed. Results The incidence of CHD in fetuses with increased NT thickness was 12.9%(18/140), which was significantly higher than 0.2%(4/1 856) of fetuses with normal NT (P<0.01). The diagnostic sensitivity and specificity were 81.8%, 93.8%, and the positive predictive rate and negative predictive rate were 12.8%, 99.8%. The inci-dence of CHD in fetuses with abnormal DV was 12.3%(19/154), which was significantly higher than 0.2%(3/1 842) of fetuses with normal DV (P<0.01). The diagnostic sensitivity and specificity were 86.4%, 93.2%, and the positive pre-dictive rate and negative predictive rate were 12.3%, 99.8%. The incidence of CHD in fetuses with increased NT thickness and abnormal DV was 26.4%(14/53), which was significantly higher than 0.1% (2/1 894) of fetuses with normal NT and DV (P<0.01). The diagnostic sensitivity and specificity were 87.5%, 98.0%, and the positive predic-tive rate and negative predictive rate were 26.4%, 88.9%. Conclusion Increased NT thickness and abnormal blood flow spectrum of DV can be used as early screening indexes for fetal congenital cardiac malformation in early pregnancy.%目的：探讨孕早期胎儿颈项透明层厚度(NT)及胎儿静脉导管血流频谱(DV)对胎儿先天性心脏畸形(CHD)的临床预测价值。方法筛查对象为1996例于2012年1月至2015年6月间就诊于我院的孕妇，在孕11~13+6周测量NT值及DV频谱，并对胎儿进行随访，分析NT和DV与胎儿先天性心脏畸形之间的关系。结果 NT增厚的胎儿CHD的发生率为12.9%(18/140)，显著高于NT正常胎儿的0.2%(4/1856)，差异有显著统计学意义(P<0.01)，其敏感性、特异性为81.8%、93.8%，阳性预测率、阴性预测率为12.8%、99.8%。DV异常的胎儿CHD的发生率为12.3%(19/154)，显著高于DV正常胎儿的0.2%(3/1842)，差异有显著统计学意义(P<0.01)，其敏感性、特异性为86.4%、93.2%，阳性预测率、阴性预测率为12.3%、99.8%。NT和DV均异常的胎儿CHD发生率为26.4%(14/53)，显著高于NT和DV均正常的胎儿的0.1%(2/1894)(P<0.01)，其敏感性、特异性为87.5%、98.0%，阳性预测率、阴性预测率为26.4%、88.9%。结论 NT增厚联合DV异常可以作为孕早期胎儿先天性心脏畸形的筛查指标。