胎儿大脑中动脉收缩期峰值流速在非免疫性水肿的研究中

Fetal middle cerebral artery peak systolic velocity in the investigation of non-immune hydrops.

作者信息

Hernandez-Andrade E, Scheier M, Dezerega V, Carmo A, Nicolaides K H

机构信息

Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.

出版信息

Ultrasound Obstet Gynecol. 2004 May;23(5):442-5. doi: 10.1002/uog.1009.

DOI:10.1002/uog.1009

PMID:15133792

Abstract

OBJECTIVE

In some cases of non-immune hydrops there is congenital or acquired fetal anemia. The aim of this study was to investigate the potential value of fetal middle cerebral artery peak systolic velocity (MCA-PSV) in the assessment and management of non-immune hydrops due to anemia.

METHODS

Fetal MCA-PSV and fetal hemoglobin concentration, in blood obtained by cordocentesis, were measured in 16 singleton pregnancies referred to our unit for further investigations because of a diagnosis of non-immune hydrops fetalis. In all cases a detailed ultrasound examination demonstrated moderate or severe ascites, with or without skin edema, and pericardial or pleural effusions. Furthermore, there were no obvious malformations to account for the hydrops. In each fetus the measured MCA-PSV and hemoglobin concentration were expressed as delta values (the difference in SD from the normal mean for gestation). Regression analysis was used to determine the significance of the association between delta MCA-PSV and delta fetal hemoglobin concentration. In addition, we searched our database to identify the sonographic features and hemoglobin concentration of fetuses with congenital infection.

RESULTS

In the 16 cases of non-immune hydrops there were seven with parvovirus B19 infection, one each of alpha-thalassemia and primary cardiomyopathy and seven with no obvious explanation for the hydrops. There was a significant association between delta MCA-PSV and delta hemoglobin concentration (delta hemoglobin = (delta MCA-PSV + 0.1437)/-0.4154; R(2) = 0.7202; P < 0.0001). In 10 of the cases the fetal hemoglobin concentration was more than 4 SD below the normal mean for gestation and in all these cases the MCA-PSV was more than 2 SD above the normal mean for gestation. Our computer search identified an additional nine fetuses with parvovirus B19 infection and in all cases the predominant sonographic finding was ascites and the hemoglobin concentration was more than 4 SD below the normal mean. In contrast, only 3/14 fetuses with cytomegalovirus, toxoplasmosis, coxsackie B or Treponema infection had ascites and only 2/14 had a hemoglobin deficit of 4-6 SD.

CONCLUSION

In the management of non-immune hydrops, measurement of fetal MCA-PSV can help identify the subgroup with fetal anemia.

摘要

目的

在某些非免疫性水肿病例中存在先天性或获得性胎儿贫血。本研究的目的是探讨胎儿大脑中动脉收缩期峰值流速（MCA-PSV）在评估和管理因贫血导致的非免疫性水肿中的潜在价值。

方法

对16例因诊断为胎儿非免疫性水肿而转诊至我院进一步检查的单胎妊娠进行胎儿MCA-PSV和经脐血穿刺获得的胎儿血红蛋白浓度测量。所有病例均经详细超声检查显示有中度或重度腹水，伴或不伴有皮肤水肿、心包或胸腔积液。此外，没有明显的畸形可解释水肿的原因。在每个胎儿中，所测的MCA-PSV和血红蛋白浓度均表示为差值（与妊娠正常均值的标准差差值）。采用回归分析来确定MCA-PSV差值与胎儿血红蛋白浓度差值之间关联的显著性。此外，我们检索了我们的数据库以确定先天性感染胎儿的超声特征和血红蛋白浓度。

结果

在16例非免疫性水肿病例中，7例感染细小病毒B19，1例为α地中海贫血，1例为原发性心肌病，7例水肿原因不明。MCA-PSV差值与血红蛋白浓度差值之间存在显著关联（血红蛋白差值 =（MCA-PSV差值 + 0.1437）/-0.4154；R² = 0.7202；P < 0.0001）。10例病例中胎儿血红蛋白浓度比妊娠正常均值低4个标准差以上，在所有这些病例中，MCA-PSV比妊娠正常均值高2个标准差以上。我们的计算机检索又发现另外9例感染细小病毒B19的胎儿，所有病例中主要的超声表现为腹水，血红蛋白浓度比正常均值低4个标准差以上。相比之下，14例感染巨细胞病毒、弓形虫、柯萨奇B病毒或梅毒螺旋体的胎儿中只有3例有腹水，只有2例血红蛋白缺乏4 - 6个标准差。