孕早期胎儿颈项透明层在产前超声筛查胎儿畸形中价值的Meta分析

ObjectiveTo evaluate the value of nuchal translucency (NT) as a screening test for fetal abnormalities in the first trimester ultrasound examination.MethodsA search in Cochrane Library, PubMed, OVID, Springer, China National Knowledge Infrastructure (CNKI) and Chinese Bio-edicine Database（CBM）was performed to identify relevant English and Chinese articles between Jan 1990 and August 2008. Criteria for inclusion were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles were extracted. Statistical analysis was performed with Meta-iSc 1.4. Heterogeneity of the included articles was tested to select proper effect model to calculate pooled weighted sensitivity and specificity. Summary receiver operating characteristic curve(SROC) was made and the area under the curve (AUC) was calculated. Finally, sensitivity analysis was performed.ResultsTwelve articles were included, with a total of 112 099 fetuses. Nine articles meeting inclusion criteria were analyzed for the value of screening for cardiac abnormalities by nuchal translucency thickness above the 95th percentile for gestational age. The pooled sensitivity and specificity was 29.8%, 96.9%，respectively, AUC=0.804 7. Seven articles meeting inclusion criteria were analyzed for the value of screening for cardiac abnormalities by nuchal translucency thickness above the 99th percentile for gestational age. The pooled sensitivity and specificity was 18.9%, 99.3%，respectively, AUC=0.971 2. Five articles meeting inclusion criteria were analyzed for the value of screening for fetal abnormalities by nuchal translucency thickness above the 95th percentile for gestational age. The pooled sensitivity and specificity was 25.0%, 98.3% respectively, AUC=0.183 0. The sensitivity of screening for cardiac abnormalities by nuchal translucency thickness above the 95th percentile for gestational age was significantly higher than the nuchal translucency thickness above the 99th percentile for gestational age（χ2=6.58， P<0.05）,no difference was found in the specificity. The random?瞖ffect model was used in the analysis of screening for cardiac abnormalities by nuchal translucency thickness above the 95th or 99th percentile for gestational age because of the heterogeneity. The fixed-ffect model was used in the analysis of screening for fetal abnormalities by nuchal translucency thickness above the 95th percentile for gestational age because of the homogenicity. ConclusionsThe results suggest that screening for fetal abnormalities by NT thickness above the 95th percentile for gestational age has a low accuracy and is unsuitable for prenatal screen. At present it is incompletely clear on the sensitivity and specificity of screening for different kinds of fetal abnormalities by NT thickness. Screening for cardiac abnormalities by first trimester NT thickness has a high accuracy and specificity and can be reliably used in prenatal screen. We need the further systemic reviews to evaluate the value of NT as a screening test for different kinds of fetal abnormalities. Further multi?瞔entre and prospective studies are badly needed to be performed to optimize the standard of nuchal translucency thickness, evaluate the value of NT as a screening test for fetal abnormalities (especially cardiac abnormalities) in the first trimester ultrasound examination by a cost-effectiveness analysis, and develop an operation guideline on first trimester nuchal translucency thickness measurement for the prenatal screening of cardiac abnormalities in China.

Meta-analysis of the value of nuchal translucency as a screening test for fetal abnormalities in the first trimester ultrasound examinatjon