切换至 "中华医学电子期刊资源库"

中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (01) : 81 -85. doi: 10.3877/cma.j.issn.1673-5250.2021.01.012

所属专题: 文献

论著

早孕期胎儿颈项透明层增厚与鼻骨缺失的产前诊断价值
吴少敏1,1, 李婵1,1, 唐莉1,1, 魏海云1,1, 杨昕2,,2()   
  • 收稿日期:2020-03-03 修回日期:2020-11-10 出版日期:2021-02-01
  • 通信作者: 杨昕

Prenatal diagnosis value of fetal increased nuchal translucency thickness and absence of nasal bone in first trimester

Shaomin Wu1,1, Chan Li1,1, Li Tang1,1, Haiyun Wei1,1, Xin Yang2,2,()   

  • Received:2020-03-03 Revised:2020-11-10 Published:2021-02-01
  • Corresponding author: Xin Yang
  • Supported by:
    National Natural Science Foundation of China(81873836)
引用本文:

吴少敏, 李婵, 唐莉, 魏海云, 杨昕. 早孕期胎儿颈项透明层增厚与鼻骨缺失的产前诊断价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2021, 17(01): 81-85.

Shaomin Wu, Chan Li, Li Tang, Haiyun Wei, Xin Yang. Prenatal diagnosis value of fetal increased nuchal translucency thickness and absence of nasal bone in first trimester[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(01): 81-85.

目的

探讨早孕期胎儿颈项透明层(NT)增厚与鼻骨缺失的产前诊断价值。

方法

选择2016年10月至2019年4月,于东莞市人民医院进行早孕期胎儿超声检查发现胎儿NT增厚和(或)鼻骨缺失的488例单胎妊娠胎儿为研究对象。回顾性分析其孕母的临床病例资料。对单纯NT增厚、单纯鼻骨缺失、NT增厚+鼻骨缺失、NT增厚+其他结构畸形、NT增厚+鼻骨缺失+其他结构畸形5种情况胎儿的染色体病发生率,采用χ2检验进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①本组接受产前诊断的NT增厚、鼻骨缺失胎儿的染色体病发生率分别为17.6%(46/262)和14.3%(29/203)。②本组单纯NT增厚、单纯鼻骨缺失、NT增厚+鼻骨缺失、NT增厚+其他结构畸形、NT增厚+鼻骨缺失+其他结构畸形5种情况胎儿的染色体病发生率分别为8.5%(17/200)、3.9%(3/77)、53.5%(23/43)、43.5%(10/23)、42.9%(6/14)。单纯NT增厚与单纯鼻骨缺失胎儿染色体病发生率比较,差异无统计学意义(χ2=1.759,P=0.090);NT增厚+鼻骨缺失、NT增厚+其他结构畸形、NT增厚+鼻骨缺失+其他结构畸形3种情况胎儿染色体病发生率比较,差异无统计学意义(χ2=0.837,P=0.658);但是这3种情况的胎儿染色体病发生率,均显著高于单纯NT增厚胎儿,并且差异均有统计学意义(χ2=52.080、23.716、16.101,均为P<0.001)。

结论

建议对早孕期孕妇进行胎儿超声检查时,将鼻骨缺失筛查列为胎儿染色体病筛查的有价值指标之一,中孕期对鼻骨缺失胎儿的影像学追踪亦很重要。早孕期胎儿NT增厚合并鼻骨缺失和(或)其他结构畸形时,强烈建议孕妇进行产前诊断,以了解胎儿染色体病发生情况。

Objective

To investigate prenatal diagnosis value of increased nuchal translucency (NT) thickness and absence of nasal bone of fetal in first trimester.

Methods

From October 2016 to April 2019, a total of 488 cases of singleton pregnancy fetus who were screened by ultrasound to confirm the increased NT thickness and/or absence of nasal bone in first trimester in Dongguan People′s Hospital were selected as research subjects. The clinical date of pregnant women of fetus were analyzed retrospectively.Chi-square test was used to compare the incidence of chromosomal abnormalities under 5 ultrasound conditions, including isolated increased NT thickness, isolated absence of nasal bone, increased NT thickness + absence of nasal bone, increased NT thickness + other structure abnormalities, and increased NT thickness + absence of nasal bone + other structure abnormalities. The procedure followed in this study was consistent with World Medical Association Declaration of Helsinki revised in 2013.

Results

①The incidence of chromosomal abnormalities of fetuses who received prenatal diagnosis and diagnosed with increased NT thickness and absence of nasal bone were 17.6% (46/262) and 14.3% (29/203), respectively. ②The incidence of chromosomal abnormalities of fetus with isolated increased NT thickness, isolated absence of nasal bone, increased NT thickness + absence of nasal bone, increased NT thickness + other structure abnormalities, and increased NT thickness + absence of nasal bone + other structure abnormalities were 8.5% (17/200), 3.9% (3/77), 53.5% (23/43), 43.5% (10/23), 42.9% (6/14), respectively. Among them, there was no significant difference of incidence of chromosomal abnormalities between fetus with isolated increased NT thickness and isolated absence of nasal bone (χ2=1.759, P=0.090). There was no significant difference of incidence of chromosomal abnormalities among fetus with the rest of 3 ultrasound conditions (χ2=0.837, P=0.658). But the incidence of chromosomal abnormalities of fetus with these 3 ultrasound conditions were all higher than that of fetus with isolated increased NT thickness, and the differences were statistically significant(χ2=52.080, 23.716, 16.101; all P<0.001).

Conclusions

Nasal bone screening should be included as a screening index of chromosomal abnormality in first trimester, and fetus with nasal bone abnormality should be followed up in second trimester. It is highly recommended that pregnant women take prenatal diagnosis while ultrasound scan showed fetus with increased NT thickness combined with absence of nasal bone and/or with other structure abnormalities to identify fetus condition of occurrence of chromosomal abnormality.

[1]
Nicolaides KH, Azar G, Byrne D, et al. Fetal nuchal translucency: ultrasound screening for chromosomal defects in first trimester of pregnancy[J]. BMJ, 1992, 304(6831):867-869. DOI: 10.1136/bmj.304.6831.867.
[2]
Tang Y, Luo H, Mu D, et al. Early diagnosis of trisomy 21, trisomy 18 and trisomy 13 using nuchal translucency thickness and ductus venosus blood flow waveform in West China[J]. Mol Med Rep, 2019, 19(2):1349-1355. DOI: 10.3892/mmr.2018.9756.
[3]
Chanprapaph P, Dulyakasem C, Phattanchindakun B. Sensitivity of multiple first trimester sonomarkers in fetal aneuploidy detection[J]. J Perinat Med, 2015, 43(3):359-365. DOI: 10.1515/jpm-2014-0201.
[4]
Dane B, Dane C, Cetin A, et al. Pregnancy outcome in fetuses with increased nuchal translucency[J]. J Perinatol, 2008, 28(6):400-404. DOI: 10.1038/jp.2008.14.
[5]
杜柳,谢红宁,郑菊,等. 颈部透明层增厚胎儿中CMA技术检测拷贝数变异的分析[J]. 中华妇产科杂志,2018, 53(10):671-676. DOI: 10.3760/cma.j.issn.0529-567x.2018.10.004.
[6]
Gu YZ, Nisbet DL, Reidy KL, et al. Hypoplastic nasal bone: a potential marker for facial dysmorphism associated with pathogenic copy number variants on microarray[J]. Prenat Diagn, 2019, 39(2):116-123. DOI: 10.1002/pd.5410.
[7]
Węgrzyn P, Czuba B, Serafin D, et al. Nasal bone in screening for T21 at 11-13+6 weeks of gestation - a multicenter study[J]. Ginekol Pol, 2016, 87(11):751-754. DOI: 10.5603/GP.2016.0082.
[8]
谢红宁,朱云晓,李丽娟,等. 对妊娠中晚期孕妇行超声检测胎儿鼻骨发育状况以筛查唐氏综合征[J]. 中华妇产科杂志,2008, 43(3):171-174. DOI: 10.3321/j.issn:0529-567X.2008.03.004.
[9]
Prefumo F, Sairam S, Bhide A, et al. Maternal ethnic origin and fetal nasal bones at 11-14 weeks of gestation[J]. BJOG, 2004, 111(2):109-112. DOI: 10.1046/j.1471-0528.2003.00025.x-i1.
[10]
Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan[J]. Ultrasound Obstet Gynecol, 2013, 41(1):102-113. DOI:10.1002/uog.12342.
[11]
Sepulveda W, Wong AE, Dezerega V. First-trimester ultrasonographic screening for trisomy 21 using fetal nuchal translucency and nasal bone[J]. Obstet Gynecol, 2007, 109(5):1040-1045. DOI:10.1097/01.AOG.0000259311.87056.5e.
[12]
杨昕,韩瑾,甄理,等.胎儿鼻骨缺失或发育不良与染色体核型异常的关系—187例分析[J]. 中华围产医学杂志,2015, 18(5):339-342. DOI: 10.3760/cma.issn.1007-9408.2015.05.05.
[13]
Sparks AB, Struble CA, Wang ET, et al. Noninvasive prenatal detection and selective analysis of cell-free DNA obtained from maternal blood: evaluation for trisomy 21 and trisomy 18[J]. Am J Obstet Gynecol, 2012, 206(4):319.e1-e9. DOI:10.1016/j.ajog.2012.01.030.
[14]
Herrera LG, Royero LR, Rodríguez NG, et al. Effectiveness of increased nuchal translucency in detecting pregnancies at risk for chromosomal abnormalities[J]. MediSur, 2014, 12(1):63-76.
[15]
Agathokleous M, Chaveeva P, Poon LC, et al. Meta-analysis of second-trimester markers for trisomy 21[J]. Ultrasound Obstet Gynecol, 2013, 41(3):247-261. DOI: 10.1002/uog.12364.
[16]
Ting YH, Lao TT, Lau TK, et al. Isolated absent or hypoplastic nasal bone in the second trimester fetus: is amniocentesis necessary?[J]. J Matern Fetal Neonatal Med, 2011, 24(4):555-558. DOI: 10.3109/14767058.2010.487140.
[17]
Desai P , Chauhan B , Jhawar M. Outcome of pregnancies with isolated absent fetal nasal bone in the second trimester[J]. J Fetal Med, 2019, 6(4): 31-34.DOI: 10.1007/s40556-019-00196-9.
[1] 戴飞, 赵博文, 潘美, 彭晓慧, 陈冉, 田园诗, 狄敏. 胎儿心脏超声定量多参数对主动脉缩窄胎儿心脏结构及功能的诊断价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 950-958.
[2] 章建全, 程杰, 陈红琼, 闫磊. 采用ACR-TIRADS评估甲状腺消融区的调查研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 966-971.
[3] 罗辉, 方晔. 品管圈在提高甲状腺结节细针穿刺检出率中的应用[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 972-977.
[4] 杨忠, 时敬业, 邓学东, 姜纬, 殷林亮, 潘琦, 梁泓, 马建芳, 王珍奇, 张俊, 董姗姗. 产前超声在胎儿22q11.2 微缺失综合征中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 852-858.
[5] 孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 884-889.
[6] 杜祖升, 赵博文, 张帧, 潘美, 彭晓慧, 陈冉, 毛彦恺. 应用二维斑点追踪成像技术评估孕周及心尖方向对中晚孕期正常胎儿左心房应变的影响[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 843-851.
[7] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[8] 张商迪, 赵博文, 潘美, 彭晓慧, 陈冉, 毛彦恺, 陈阳, 袁华, 陈燕. 中晚孕期胎儿心房内径定量评估心房比例失调胎儿心脏畸形的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 785-793.
[9] 王秋莲, 张莹, 李春敏, 徐树明, 张玉奇. 胎儿主动脉弓部梗阻伴发复杂心内畸形的产前超声诊断及漏误诊分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 718-725.
[10] 顾莉莉, 姜凡. 安徽省超声产前筛查切面图像质量现状调查情况及分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 671-674.
[11] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[12] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[13] 曾晴, 文华轩, 袁鹰, 廖伊梅, 秦越, 罗丹丹, 梁美玲, 李胜利. 经腹二维超声评价胎儿大脑外侧裂的新参数——外侧裂平台角度[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 454-459.
[14] 王水清, 赵博文, 潘美, 彭晓慧, 陈冉, 马明明, 狄敏. 16~40周正常胎儿左心房后间隙指数及其Z评分的定量研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 460-469.
[15] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
阅读次数
全文


摘要