妊娠早期超声标记预测胎儿常见三体综合征的价值

目的探讨妊娠早期超声标记预测胎儿常见三体综合征（21-三体综合征、18-三体综合征、13-三体综合征）的价值。 方法分析2014年9月至2016年5月在首都医科大学附属北京妇产医院行妊娠早期（11~13^＋6周）产前超声检查且染色体检查判定为21-三体、18-三体、13-三体综合征（染色体异常组173例）及同期染色体检查判定为正常（对照组1391例）共1564例胎儿的超声影像学指标,通过计算受试者工作曲线下面积、敏感度、特异度、约登指数等比较不同超声指标组合预测染色体异常的效果。 结果多元Logistic回归预测模型提示：孕妇年龄（OR=1.05,95%CI：1.01~1.10）、鼻骨发育不全（OR=14.54,95%CI：2.28~92.75）、颈项透明层（NT）增厚（OR=12.46,95%CI：8.27~18.78）、头臀径小于孕周（OR=12.79,95%CI：1.45~113.14）、胎儿水肿（OR=9.69,95%CI：3.55~26.48）为常见三体综合征的危险因素,建立模型（Model A）的效果为：曲线下面积0.770、敏感度0.630、特异度0.904、约登指数0.534;NT增厚及年龄作为自变量,建立多元Logistic回归模型（Model B）的效果为：曲线下面积0.756、敏感度0.618、特异度0.907、约登指数0.525;NT增厚和年龄作为单独变量,将其他8个超声标记组合成新变量"其他异常" ,建立多元Logistic回归模型（Model C）的效果为：曲线下面积0.775、敏感度0.642、特异度0.902、约登指数0.543。 结论妊娠早期超声标记中的NT增厚对预测胎儿常见三体综合征有重要意义,其他超声指标联合可一定程度上优化预测效果。

Ultrasonic markers of first trimester in prediction of common trisomy syndromes in fetuses

ObjectiveTo explore the value of ultrasonic markers of first trimester in prediction of trisomy 21, trisomy 18 and trisomy 13 syndrome. MethodsTotally 1564 pregnant women were collected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University from September 2014 to May 2016. All the cases underwent the ultrasound screening during 11 to 13^{+ 6} weeks and the chromosome results were Trisomy 21, Trisomy 18, Trisomy 13 or normal. The effects of using different kinds of ultrasonic markers combination to predict chromosomal abnormalities were evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity and Youden index. ResultsThe results of multivariate Logistic regression model suggested that maternal age (OR=1.05, 95%CI: 1.01-1.10), nasal bone hypoplasia (OR=14.54, 95%CI: 2.28-92.75), nuchal translucency (NT) thickening (OR=12.46, 95%CI: 8.27-18.78), the crown-rump length (GRL) decrease (OR=12.79, 95%CI: 1.45-113.14), fetal edema (OR=9.69, 95%CI: 3.55-26.48) were the risk factors of common trisomy syndromes. Using these factors to establish Model A, the the AUC, sensitivity, specificity and Youden index of were 0.770, 0.630, 0.904 and 0.534. While the results of using NT thickening and age to establish the multiple Logistic regression model (Model B) were 0.756, 0.618, 0.907 and 0.525. NT thickening and age were used as single variable, and the other 8 ultrasonic markers were combined into a new variable (other abnormality), and the results of establishing a multiple Logistic regression model (Model C) were 0.775, 0.642, 0.902 and 0.543. ConclusionNT thickening in early pregnancy ultrasonic markers is of great significance in predicting the common trisomy syndromes in fetuses, and the combination of other ultrasonic indicators can optimize the prediction effect to some extent.