孕早期超声测量胎儿腹主动脉与肠系膜上动脉夹角用于预测先天性膈疝北大核心CSCD

目的观察孕早期采用超声测量胎儿腹主动脉与肠系膜上动脉(SMA)夹角(AS角)预测先天性膈疝(CDH)的价值。方法纳入206胎接受超声检查的孕早期胎儿,其中200胎正常,5胎经随访证实为CDH、1胎为巨大脐膨出;测量胎儿AS角及头臀长(CRL)。以组内相关系数(ICC)评价观察者间测量结果的一致性;采用Pearson相关性评价正常胎儿AS角与CRL的相关性。结果2名观察者测量AS角及CRL的一致性良好(ICC均>0.75,P均<0.05)。正常胎儿AS角平均为(37.02±9.41)°,AS角与CRL无明显相关(R^(2)=0.0004,P=0.783)。5胎CDH中,3胎为孤立性左侧膈疝,1胎为左侧膈疝合并多发畸形,1胎为右侧膈疝合并多发畸形,孕早期AS角均明显增大(73°~119°)。1胎孕早期SMA走行明显异常,AS角150°,超声诊断为巨大脐膨出。结论超声测量孕早期胎儿AS角操作简便,且不受胎儿大小影响;AS角增大可能对预测胎儿CDH具有一定价值。

Early pregnancy ultrasonic measurement of angle between abdominal aorta and superior mesenteric artery in fetus in predicting congenital diaphragmatic hernia

Objective To observe the value of ultrasonic measurement of angle (AS angle) between fetal abdominal aorta and superior mesenteric artery (SMA) in early pregnancy for predicting congenital diaphragmatic hernia (CDH).Methods A total of 206 fetuses in early pregnancy were enrolled, including 200 normal fetuses, 5 fetuses with were CDH confirmed with follow-up and 1 with giant omphalocele. The AS angle and crown-rump length (CRL) of fetuses were measured. Intra-class correlation coefficient (ICC) was used to evaluate the intra-observer consistency of measurement results of the above parameters. Pearson correlation was used to evaluate the correlation between AS angle and CRL in normal fetuses.Results The intra-observer consistency of AS angle and CRL were both good (both ICC > 0.75, both P < 0.05). The average of AS angle in normal fetuses was (37.02±9.41)°, and no significant correlation was found between AS angle and CRL (R²=0.0004, P=0.783). In early pregnancy, AS angle found significantly increased (73°-119°) in 5 fetuses with CDH, including 3 fetuses with isolated left diaphragmatic hernia, 1 with left diaphragmatic hernia and multiple malformations, 1 with right diaphragmatic hernia and multiple malformations. The AS angle was 150° in 1 fetus with abnormal SMA, which was diagnosed giant omphalocele with ultrasound.Conclusion Ultrasound measurement of fetal AS angle in early pregnancy was simple and not affected by fetal size. The increase of AS angle might be of some value for predicting fetal CDH.