Bekker Mireille N, Twisk Jos W R, Bartelings Margot M, Gittenberger-de Groot Adriana C, van Vugt John M G
Department of Obstetrics, VU University Medical Center, Amsterdam, the Netherlands.
Obstet Gynecol. 2006 Oct;108(4):846-53. doi: 10.1097/01.AOG.0000238340.64966.81.
To study the relationship between the volume of the jugular lymphatic sacs and nuchal translucency thickness in fetuses with increased nuchal translucency with advancing gestation.
Seventy-four fetuses with a nuchal translucency greater than the 95th percentile were examined weekly between 11 and 17 weeks of gestational age. The fetal neck region was studied by ultrasonography, followed by measurement of nuchal translucency and jugular lymphatic sacs. The measurements were analyzed using multilevel analysis. In case of termination of pregnancy postmortem examination was performed.
In 40 euploid fetuses and 34 aneuploid fetuses, 159 measurements of jugular lymphatic sac volume and nuchal translucency thickness were analyzed. The volume of the jugular lymphatic sacs and gestational age showed a quadratic relation, which differed between euploid and aneuploid fetuses (P < .01). The maximum volumes were larger and present longer in fetuses with aneuploidy than in euploid fetuses (P < .01). In case of a cardiac anomaly, jugular lymphatic sac volume was larger than in cardiac normal fetuses (nonsignificant). Furthermore, the development of jugular lymphatic sac volume and increased nuchal translucency were related, whereby an increase of the nuchal translucency preceded enlargement of the jugular lymphatic sacs (P < .001). In each fetus an increase in jugular lymphatic sac volume was followed by a decrease with advancing gestation. The gestational age at maximum jugular lymphatic sac volume differed between fetuses, indicating a fetus-specific pattern. Nuchal translucency development showed a similar pattern. Postmortem examination confirmed distension of the jugular lymphatic sacs in all cases.
Increased nuchal translucency is associated with abnormal lymphatic development, in which nuchal translucency enlargement precedes enlargement of jugular lymphatic sacs on ultrasound examination. Aneuploid fetuses have a more disturbed lymph angiogenesis.
III.
研究孕早期颈部透明带增厚胎儿的颈淋巴囊体积与颈部透明带厚度之间的关系。
对74例颈部透明带厚度大于第95百分位数的胎儿在孕11至17周期间每周进行检查。通过超声检查胎儿颈部区域，随后测量颈部透明带和颈淋巴囊。测量结果采用多水平分析。如果终止妊娠，则进行尸检。
对40例整倍体胎儿和34例非整倍体胎儿的159次颈淋巴囊体积和颈部透明带厚度测量结果进行了分析。颈淋巴囊体积与孕周呈二次关系，整倍体和非整倍体胎儿之间存在差异（P < 0.01）。非整倍体胎儿的颈淋巴囊最大体积更大且持续时间更长（P < 0.01）。如果存在心脏异常，颈淋巴囊体积大于心脏正常的胎儿（无统计学意义）。此外，颈淋巴囊体积的发育与颈部透明带增厚有关，颈部透明带增厚先于颈淋巴囊增大（P < 0.001）。在每个胎儿中，颈淋巴囊体积随着孕周增加先增大后减小。颈淋巴囊最大体积时的孕周在不同胎儿之间存在差异，表明存在胎儿特异性模式。颈部透明带发育呈现类似模式。尸检证实所有病例中颈淋巴囊均有扩张。
颈部透明带增厚与淋巴管发育异常有关，超声检查时颈部透明带增宽先于颈淋巴囊增大。非整倍体胎儿的淋巴管生成紊乱更严重。
III级
