胎儿颜面轮廓的超声研究

发布时间：2018-04-28 09:09

  本文选题：胎儿 + 鼻骨　； 参考：《北京协和医学院》2014年博士论文

【摘要】：目的 应用二维及三维超声测量多个颜面相关指标评估胎儿颜面轮廓,并比较两种方法的测量稳定性,对初步建立中国人群正常胎儿的颜面轮廓生长发育趋势进行尝试性研究。 资料与方法 2013年4月-2014年2月期间于我院进行产科超声检查的孕11周～38周孕妇共439例。 联合评估胎儿颜面轮廓的各项指标：1.确定测量切面即颜面正中矢状面的标志性结构；2.测量鼻骨长度(nasal bone length,NBL)、鼻前组织厚度(prenasal thi-ckness,PT),并计算PT/NBL；3.确定颜面轮廓线(facial profile line,FPL)的三种分型,即零,阴性和阳性,阳性时测量FPL到额骨外缘的距离F；4.规范各颜面角度如额-上颌角(frontomaxillary facial angle,FMF)、额-鼻角(frontonasal angle,FNA)、上下颌面角(mandibulomaxillary facial angle,MMF)、上颌-鼻根-下颌角(maxilla-nasion-mandible angle, MNM)的定义。 在最先获取的100个样本中随机抽取30例进行二维和三维之间的测量一致性分析；并对两种方法在不同测量者间,及同一测量者内的不同次测量间,进行测量稳定性的分析。 选取稳定性良好且操作简单的方法进行所有胎儿颜面结构的测量。建立初步的胎儿颜面轮廓发育趋势,并分析颜面轮廓与孕周(gestational age,GA)的关系。 结果 1、一致性分析：30例样本均分析NBL、PT、PT/NBL、FMF、FNA、MMF和MNM,上述各测量指标二维与三维测量方法的组内相关系数(intra-class correlationcoefficient,ICC)分别为0.984、0.985、0.751、0.780、0.838、0.760、0.729；二维超声在同一测量者不同次测量之间的ICC分别为0.994、0.994、0.741、0.891、0.963、0.887、0.954；二维超声在不同测量者间的ICC分别为0.982、0.890、0.708、0.815、0.903、0.811、0.917：三维超声在同一测量者不同次测量之间的ICC分别为0.997、0.996、0.878、0.968、0.962、0.974、0.988；三维超声在不同测量者间的ICC分别为0.994、0.991、0.746、0.948、0.905、0.874、0.889。对于FPL,二维及三维方法评估显示分类结果一致。 2、胎儿NBL与PT随孕周而增大,其关系方程式符合S曲线,方程分别为：NBL=e3.097-30.563/GA, PT=e2.703-30.093/GA;PT/NBL在整个孕周保持稳定,平均值为0.70。 3、正常胎儿FPL无“阴性”结果。多数结果为“零”,占92.26%,“阳性”结果占7.74%,集中在11-13周及26-38周,“阳性”时测量F值范围0.10-0.51cm(0.24±0.10cm)。 4、胎儿各颜面角度发育与孕周相关,关系方程式均符合三次多项式：FMF角与孕周呈负相关,方程式：FMF角=135.300-6.473×GA+0.235×GA2-0.003×GA3(R2=0.240,P=0.000)；FNA与孕周呈正相关,方程式：FNA=58.920+7.452xGA-0.274×GA2-0.003×GA3(R2=0.297, P=0.000); MMF角与孕周呈负相关,方程式：MMF=132.329-5.337xGA+0.191×GA2-0.002xGA3(R2=0.304, P=0.000);MNM角与孕周呈正相关,方程式：MNM=-24.592+4.653×GA-0.173×GA2+0.002xGA3(R2=0.413,P=0.000)。 结论 1、对颜面轮廓各指标定义进行规范后,三维超声评估胎儿颜面轮廓的观察者内及观察者间一致性较好,临床应用中具有明显优势 2、胎儿鼻骨长度及鼻前组织厚度与孕周密切相关,随孕周呈S曲线增长,鼻前组织厚度与鼻骨长度之比在整个孕周保持稳定 3、正常胎儿颜面轮廓线无“阴性”表现 4、胎儿颜面角度变化与孕周相关,曲线拟合三次多项式相关程度最高 目的 回顾分析染色体异常胎儿颜面轮廓的特点,评估颜面轮廓相关指标对染色体异常的提示价值 资料与方法 病例组选取2008年3月-2013年1月期间于我院进行产科超声检查并有明确染色体结果的胎儿共26例,其中21-三体21例,18-三体5例。对照组随机选取正常胎儿325例。 回顾分析胎儿颜面正中矢状面图像,联合评估颜面轮廓的各项指标：1..测量鼻骨长度(nasal bone length, NBL)、鼻前组织厚度(prenasal thickness,PT),并计算PT/NBL；2.确定颜面轮廓线(facial profile line,FPL)的三种分型,即零,阴性和阳性,阳性时测量FPL到额骨外缘的距离F；3.规范各颜面角度如额-上颌角(frontomaxillary facial angle,FMF)、额-鼻角(frontonasal angle,FNA)、上下颌面角(]mandibulomaxillary facial angle,MMF)、上颌-鼻根-下颌角(maxilla-nasion-mandible angle,MNM)的定义。 将上述颜面轮廓的各相关指标与对照组正常胎儿各参考值范围进行对比分析,评估染色体异常胎儿与正常胎儿之间的差异。 结果 1、21-三体胎儿 21例21-三体胎儿中,11例鼻骨缺失,余10例胎儿的NBL与对照组正常胎儿无明显差异(P0.05)。21-三体胎儿PT明显增厚,平均值为5.67mm,与正常胎儿的平均值4.21mm存在显著差异(P0.05),并且76.2%(16/21)高于正常胎儿第95百分位数。存在鼻骨的10例21-三体胎儿计算PT/NBL,平均值为1.21,明显大于正常胎儿的平均值0.69(P0.05)。 21-三体胎儿FPL14例为“零”,4例“阳性”(F值0.23-0.55cm),3例“阴性”。3例FPL“阴性”的胎儿存在前额扁平。 21-三体胎儿与正常胎儿在FMF角与MNM角之间存在显著差异(P0.05)。在21-三体胎儿中,95.2%(20/21)的FMF角大于正常胎儿的平均值,38.1%(8/21)大于正常胎儿的第95百分位数；85.7%(18/21)的MNM角小于正常胎儿的平均值。 2、18-三体胎儿5例18-三体胎儿中,NBL、PT及PT/NBL与正常胎儿无明显差异(P0.05)。18-三体胎儿2例FPL为“零”,3例“阴性”,无“阳性”结果。3例FPL“阴性”的胎儿均存在小下颌。 18-三体胎儿与正常胎儿在MMF角与MNM角之间存在显著差异(P0.05)。在18-三体胎儿中,100%(5/5)的MMF角小于正常胎儿的平均值,40%小于正常胎儿的第5百分位数；100%(5/5)的MNM角大于正常胎儿的平均值,40%大于正常胎儿的第95百分位数。 结论 1、颜面正中矢状面可为筛查胎儿染色体异常提供多个信息,该切面应作为中孕超声筛查的常规内容 2、鼻骨及鼻前组织厚度的测量对于21-三体的筛查意义明确,FMF及MNM角有助于提示颜面扁平,可作为筛查21-三体的辅助超声标记 3、MMF及MNM角可提示小下颌,对诊断18-三体具有一定意义 4、FPL可初步判断胎儿前额及下颌异常
[Abstract]:objective
Two dimensional and three-dimensional ultrasound measurements were used to assess the facial contour of the fetus, and the measurement stability of the two methods was compared. The growth and development trend of the facial contour of normal fetuses in Chinese population was preliminarily studied.
Information and methods
In April 2013 -2014 February, 439 cases of pregnant women who underwent obstetric ultrasound examination in our hospital from 11 weeks to 38 weeks were examined.
A joint assessment of the facial contour of the fetus: 1. to determine the mark structure of the facial facial median sagittal plane, and 2. to measure the length of the nasal bone (nasal bone length, NBL), the thickness of the anterior nasal tissue (prenasal thi-ckness, PT), and to calculate PT/NBL; 3. to determine the three types of facial contour (facial profile line, FPL), that is, zero, negative and negative. The positive and positive measurement of FPL to the outer edge of the frontal bone was F; 4. the facial angles such as the frontal maxillary angle (frontomaxillary facial angle, FMF), the frontal nose angle (frontonasal angle, FNA), the upper and lower maxillofacial angles (mandibulomaxillary facial angle,), the maxillary nasal root mandibular angle were defined.
In the first 100 samples, 30 cases were randomly selected to analyze the consistency between two and three dimensions, and the stability analysis was carried out between the two methods between the different surveyors and the different measurements within the same surveyor.
All fetal facial structures were measured with good stability and simple operation. A preliminary development trend of fetal facial contour was established and the relationship between facial contour and gestational age (GA) was analyzed.
Result
1, conformance analysis: 30 samples were all analyzed NBL, PT, PT/NBL, FMF, FNA, MMF and MNM. The intra group correlation coefficient (intra-class correlationcoefficient, ICC) of the two dimensions and three dimensional measurements were 0.984,0.985,0.751,0.780,0.838,0.760,0.729, and two dimensional ultrasound was respectively between the same surveyors. For 0.994,0.994,0.741,0.891,0.963,0.887,0.954, the ICC of two dimensional ultrasound between the different surveyors is 0.982,0.890,0.708,0.815,0.903,0.811,0.917, respectively: the ICC of the three dimensional ultrasound between the different measurements of the same surveyor is 0.997,0.996,0.878,0.968,0.962,0.974,0.988, and the ICC of the three dimensional ultrasound between the different surveyors is 0., respectively. 994,0.991,0.746,0.948,0.905,0.874,0.889.'s evaluation of FPL, 2D and 3D methods shows that the classification results are consistent.
2, the fetal NBL and PT increased with the gestational weeks, and the relation equation conformed to the S curve. The equations were NBL=e3.097-30.563/GA, PT=e2.703-30.093/GA; PT/NBL remained stable at the whole pregnancy, the average value was 0.70.
3, normal fetal FPL had no "negative" results. Most of the results were "zero", accounting for 92.26%, and "positive" results accounted for 7.74%, concentrated in 11-13 and 26-38 weeks, and the F value range was 0.10-0.51cm (0.24 + 0.10cm) when "positive" was "positive".
4, the development of the fetal facial angle is related to the gestational age, and the relation equation conforms to the three polynomial polynomial: the FMF angle is negatively correlated with the gestational week, the equation is FMF angle =135.300-6.473 x GA+0.235 x GA2-0.003 * GA3 (R2=0.240, P=0.000); FNA is positively correlated with pregnancy, and the equation: FNA=58.920 +7.452xGA-0.274 * GA2-0.003 * * Negative correlation with gestational weeks, the equation: MMF=132.329-5.337xGA+0.191 x GA2-0.002xGA3 (R2=0.304, P=0.000); MNM angle was positively correlated with gestational weeks, and the equation was MNM=-24.592+4.653 * GA-0.173 x GA2+0.002xGA3 (R2=0.413, P=0.000).
conclusion
1, after standardizing the definition of facial contour, the consistency between the observers and the observers in the assessment of the facial contour of the fetus with three-dimensional ultrasound is better, and the clinical application has obvious advantages.
2, the length of the fetal nasal bone and the thickness of the anterior nasal tissue were closely related to the gestational age. The S curve increased with the gestational age. The ratio of the thickness of the anterior nasal tissue to the length of the nasal bone remained stable at the whole pregnancy.
3, there is no "negative" expression in the facial contour of normal fetus
4, the change of fetal facial angle is related to gestational age, and the degree of correlation is the highest in curve fitting three times polynomial.
objective
Retrospective analysis of the characteristics of fetal facial contour of chromosomal abnormalities and evaluation of the value of facial contour related indicators for chromosomal abnormalities
Information and methods
In the case group, 26 cases of fetus were selected in our hospital during the period of March 2008 -2013 year and January, including 21 cases of 21- trisomy, 5 cases of 18- trisomy, and 325 cases of normal fetuses in the control group.
A retrospective analysis of the median sagittal image of the fetal face and the joint assessment of facial contour: 1.. Bone length (NBL), prenasal thickness (PT) and PT/NBL (prenasal thickness, PT), and three types of facial contour lines (facial profile line) were determined, which were zero, negative and positive, and measured positive when positive. The distance to the outer edge of the frontal bone is F; 3. the facial angles such as the frontal maxillary angle (frontomaxillary facial angle, FMF), the frontal nose angle (frontonasal angle, FNA), the upper and lower maxillofacial angles (]mandibulomaxillary facial angle, MMF), and the maxillary nasal root mandibular angle are defined.
The relative indexes of the facial contour were compared with the reference values of the normal fetuses of the control group, and the differences between the abnormal fetal chromosomes and the normal fetuses were evaluated.
Result
1,21- trisomy fetus
In 21 cases of 21- trisomy fetus, 11 cases of nasal bone loss and 10 cases of fetal NBL were not significantly different from normal fetuses (P0.05).21- trisomy fetal PT was significantly thickened, the average value was 5.67mm, and the average value of 4.21mm in the normal fetus was significantly different (P0.05), and 76.2% (16/21) was higher than the normal fetus ninety-fifth percentile. 10 cases of 21- three of the nasal bone were present. The average PT/NBL of fetal fetuses was 1.21, which was significantly larger than that of normal fetuses of 0.69 (P0.05).
FPL14 of 21- trisomy fetus was "zero", 4 cases were "positive" (F value 0.23-0.55cm), 3 cases were "negative".3 cases, and FPL negative fetus had flat forehead.
There was a significant difference between the 21- triad and the normal fetus between the FMF angle and the MNM angle (P0.05). In the 21- trisomy fetus, the FMF angle of 95.2% (20/21) was greater than the average of the normal fetus, 38.1% (8/21) was greater than the ninety-fifth percentile of the normal fetus, and the MNM angle of 85.7% (18/21) was less than the average value of the normal fetus.
In 5 cases of 2,18- trisomy fetus, there were no significant differences in NBL, PT and PT/NBL with normal fetus (P0.05), 2 cases of.18- trisomy fetus were "zero", 3 cases were "negative", and no "positive" results of.3 cases of FPL "negative" fetus all had small mandibular.
There was a significant difference between the 18- triad and the normal fetus between the MMF angle and the MNM angle (P0.05). In the 18- trisomy fetus, the MMF angle of 100% (5/5) was less than the average of the normal fetus, 40% was less than the fifth percentile of the normal fetus, and the MNM angle of 100% (5/5) was greater than the average of the normal fetus, 40% greater than the ninety-fifth percentile of the normal fetus.
conclusion
1, the face median sagittal plane can provide multiple information for screening fetal chromosomal abnormalities, which should be used as a routine screening for ultrasound screening in the second trimester.
2, the measurement of the thickness of the nasal bone and anterior nasal tissue is significant for the screening of 21- trisomy. FMF and MNM angle can help to indicate flat face, which can be used as an auxiliary ultrasonic marker for screening 21- trisomy.
3, MMF and MNM angle can hint the mandible, which is of certain significance in diagnosing 18- trisomy.
4, FPL can preliminarily judge the fetal frontal and mandibular abnormality

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R714.5;R445.1
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本文编号：1814643