[五种不同超声参数对致死性胎儿肺发育不全诊断的比较]

[Comparison of five different ultrasonographic parameters for diagnosis of lethal fetal pulmonary hypoplasia].

作者信息

Liang Qin, Zhou Qi-Chang, Peng Qing-Hai, Zhang Ming, Sun Wei, Cao Dan-Ming, Ding Yi-Ling

机构信息

Department of Ultrosound, Second Xiangya Hospital, Central-South University, Changsha 410011, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2008 May;43(5):332-5.

PMID:18953864

Abstract

OBJECTIVE

To evaluate the clinic value of five different ultrasonographic fetal parameters for prenatal diagnosis of pulmonary hypoplasia.

METHODS

Two hundred and seventy-one normal singleton pregnancies with well-established dates between 20 and 40 weeks of gestation were studied to establish normal reference range of five different ultrasonographic fetal parameters. The five parameters, which could reflect fetal lung mass, were as follows: lung area/body weight ratio, lung area, thoracic circumference/ abdominal circumference ratio, lung area/thoracic area ratio and lung area/head circumference. Thirty pregnancies with risk factors for pulmonary hyperplasia were studied for the usefulness of five parameters. Two or more standard deviations below the mean control group measurement were considered abnormal. The prenatal ultrasonic diagnoses of pulmonary hyperplasia were confirmed at neonatal follow-up examinations, on autopsy and by pathologic findings.

RESULTS

Lung area and lung area/head circumference increased with gestational age, lung area /body weight ratio decreased with gestational age. The relationships among the two ratios (thoracic circumference/abdominal circumference ratio, lung area/thoracic area ratio) and gestational age were relatively constant. Abnormal lung area/body weight ratio had a higher diagnostic accuracy than other parameters. Sensitivity of the parameters, including lung area, lung area/body weight ratio, thoracic circumference/abdominal circumference ratio, lung area/thoracic area ratio and lung area/head circumference were 83%, 97%, 50%, 70% and 87% , respectively. Sensitivity of the lung area/body weight ratio was 95% (20/21 fetuses); specificity, 9/9 fetuses; positive predictive value, 100% (20/20 fetuses); negative predictive value, 9/10; and accuracy 97% (29/30 fetuses).

CONCLUSION

Lung area/ body weight ratio is a good predictor of pulmonary hypoplasia.

摘要

目的

评估五种不同超声胎儿参数在产前诊断肺发育不全中的临床价值。

方法

研究271例孕龄在20至40周之间、孕周明确的正常单胎妊娠，以建立五种不同超声胎儿参数的正常参考范围。这五个可反映胎儿肺体积的参数如下：肺面积/体重比、肺面积、胸围/腹围比、肺面积/胸廓面积比和肺面积/头围。研究30例有肺发育不全危险因素的妊娠，以评估这五个参数的实用性。低于平均对照组测量值两个或更多标准差被视为异常。肺发育不全的产前超声诊断在新生儿随访检查、尸检及病理检查中得到证实。

结果

肺面积和肺面积/头围随孕周增加，肺面积/体重比随孕周降低。两个比值（胸围/腹围比、肺面积/胸廓面积比）与孕周的关系相对恒定。异常的肺面积/体重比诊断准确性高于其他参数。各参数的敏感性，包括肺面积、肺面积/体重比、胸围/腹围比、肺面积/胸廓面积比和肺面积/头围，分别为83%、97%、50%、70%和87%。肺面积/体重比的敏感性为95%（20/21例胎儿）；特异性为9/9例胎儿；阳性预测值为100%（20/20例胎儿）；阴性预测值为9/10；准确性为97%（29/30例胎儿）。