胎儿大脑中动脉收缩峰期血流速度与二维超声预测重型α地中海贫血的对比研究

目的:探讨和比较应用超声多普勒技术测量胎儿大脑中动脉收缩峰期血流速度(MCA-PSV)与二维超声预测胎儿重型α地中海贫血(地贫)的价值。方法:为129例具有重型α地贫风险的胎儿行二维及多普勒超声检查,测量胎儿MCA-PSV并行羊膜腔穿刺或脐血穿刺术进行α地贫基因诊断。MCA-PSV用中位数的倍数(MOM)表示。结果:重型α地贫胎儿MCA-PSV明显高于非重型α地贫胎儿,差异有显著的统计学意义(P0.001)。MCA-PSV1.29MOM预测胎儿重型α地贫的检出率为81.25%,高于二维超声(P0.05);MCA-PSV联合二维超声对胎儿重型α地贫的检出率为90.63%。MCA-PSV最早可在孕16周预测胎儿重型α地贫,MCA-PSV预测胎儿重型α地贫的平均孕龄小于二维超声(P0.05)。结论:MCA-PSV预测胎儿重型α地贫优于二维超声。MCA-PSV联合二维超声可提高胎儿重型α地贫的检出率。超声多普勒测量胎儿MCA-PSV对早期预测胎儿重型α地贫,早期处理以减少产科并发症的发生具有临床价值。

Comparison of fetal middle cerebral artery peak systolic velocity and two-dimensional imaging in predicting fetuses with Hemoglobin Bart's Hydrops Fetalis Syndrome

Objective:To investigate and compare the value of the middle cerebral artery peak systolic velocity(MCA-PSV) by color Doppler ultrasonography and two-dimensional imaging in predicting fetuses with Hemoglobin Bart's Hydrops Fetalis Syndrome.Methods:129 pregnancies at risk for fetal α-thalassemia were performed with two-dimensional ultrasound and Doppler imaging.The MCA-PSV was measured.All fetuses were detected α-thalassemia genotypes by amniocentesis or cordocentesis.MCA-PSV was expressed as multiples of the median(MOM).Results:The group of fetuses with Hemoglobin Bart's Hydrops Fetalis Syndrome had significantly higher MCA-PSV,compared to the fetuses without Hemoglobin Bart's Hydrops Fetalis Syndrome(P<0.001).The detection rate of MCA-PSV>1.29MOM in prediction of Hemoglobin Bart's Hydrops Fetalis Syndrome was 81.25%,which was higher than two-dimensional imaging(P<0.05),meanwhile,combined MCA-PSA with two-dimensional imaging reach a detection rate of 90.63%.The earliest time for MCA-PSV to predict Hemoglobin Bart's Hydrops Fetalis Syndrome was 16 gestational weeks.The average gestational age of MCA-PSV in prediction of Hemoglobin Bart's Hydrops Fetalis Syndrome was smaller than two-dimensional imaging(P<0.05).Conclusion:MCA-PSV is better than two-dimensional imaging in the prediction of Hemoglobin Bart's Hydrops Fetalis Syndrome.Combined MCA-PSV with two-dimensional imaging could further raise the detection rate of Hemoglobin Bart's Hydrops Fetalis Syndrome.Measurement of MCA-PSV by Doppler ultrasound in early prediction of Hemoglobin Bart's Hydrops Fetalis Syndrome can help reduce the incidence of obstetric complication by early treatment.