本文選題：胎兒 + 鼻骨�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2014年博士論文

【摘要】：目的 應(yīng)用二維及三維超聲測(cè)量多個(gè)顏面相關(guān)指標(biāo)評(píng)估胎兒顏面輪廓,并比較兩種方法的測(cè)量穩(wěn)定性,對(duì)初步建立中國人群正常胎兒的顏面輪廓生長發(fā)育趨勢(shì)進(jìn)行嘗試性研究。 資料與方法 2013年4月-2014年2月期間于我院進(jìn)行產(chǎn)科超聲檢查的孕11周～38周孕婦共439例。 聯(lián)合評(píng)估胎兒顏面輪廓的各項(xiàng)指標(biāo)：1.確定測(cè)量切面即顏面正中矢狀面的標(biāo)志性結(jié)構(gòu)；2.測(cè)量鼻骨長度(nasal bone length,NBL)、鼻前組織厚度(prenasal thi-ckness,PT),并計(jì)算PT/NBL；3.確定顏面輪廓線(facial profile line,FPL)的三種分型,即零,陰性和陽性,陽性時(shí)測(cè)量FPL到額骨外緣的距離F；4.規(guī)范各顏面角度如額-上頜角(frontomaxillary facial angle,FMF)、額-鼻角(frontonasal angle,FNA)、上下頜面角(mandibulomaxillary facial angle,MMF)、上頜-鼻根-下頜角(maxilla-nasion-mandible angle, MNM)的定義。 在最先獲取的100個(gè)樣本中隨機(jī)抽取30例進(jìn)行二維和三維之間的測(cè)量一致性分析；并對(duì)兩種方法在不同測(cè)量者間,及同一測(cè)量者內(nèi)的不同次測(cè)量間,進(jìn)行測(cè)量穩(wěn)定性的分析。 選取穩(wěn)定性良好且操作簡單的方法進(jìn)行所有胎兒顏面結(jié)構(gòu)的測(cè)量。建立初步的胎兒顏面輪廓發(fā)育趨勢(shì),并分析顏面輪廓與孕周(gestational age,GA)的關(guān)系。 結(jié)果 1、一致性分析：30例樣本均分析NBL、PT、PT/NBL、FMF、FNA、MMF和MNM,上述各測(cè)量指標(biāo)二維與三維測(cè)量方法的組內(nèi)相關(guān)系數(shù)(intra-class correlationcoefficient,ICC)分別為0.984、0.985、0.751、0.780、0.838、0.760、0.729；二維超聲在同一測(cè)量者不同次測(cè)量之間的ICC分別為0.994、0.994、0.741、0.891、0.963、0.887、0.954；二維超聲在不同測(cè)量者間的ICC分別為0.982、0.890、0.708、0.815、0.903、0.811、0.917：三維超聲在同一測(cè)量者不同次測(cè)量之間的ICC分別為0.997、0.996、0.878、0.968、0.962、0.974、0.988；三維超聲在不同測(cè)量者間的ICC分別為0.994、0.991、0.746、0.948、0.905、0.874、0.889。對(duì)于FPL,二維及三維方法評(píng)估顯示分類結(jié)果一致。 2、胎兒NBL與PT隨孕周而增大,其關(guān)系方程式符合S曲線,方程分別為：NBL=e3.097-30.563/GA, PT=e2.703-30.093/GA;PT/NBL在整個(gè)孕周保持穩(wěn)定,平均值為0.70。 3、正常胎兒FPL無“陰性”結(jié)果。多數(shù)結(jié)果為“零”,占92.26%,“陽性”結(jié)果占7.74%,集中在11-13周及26-38周,“陽性”時(shí)測(cè)量F值范圍0.10-0.51cm(0.24±0.10cm)。 4、胎兒各顏面角度發(fā)育與孕周相關(guān),關(guān)系方程式均符合三次多項(xiàng)式：FMF角與孕周呈負(fù)相關(guān),方程式：FMF角=135.300-6.473×GA+0.235×GA2-0.003×GA3(R2=0.240,P=0.000)；FNA與孕周呈正相關(guān),方程式：FNA=58.920+7.452xGA-0.274×GA2-0.003×GA3(R2=0.297, P=0.000); MMF角與孕周呈負(fù)相關(guān),方程式：MMF=132.329-5.337xGA+0.191×GA2-0.002xGA3(R2=0.304, P=0.000);MNM角與孕周呈正相關(guān),方程式：MNM=-24.592+4.653×GA-0.173×GA2+0.002xGA3(R2=0.413,P=0.000)。 結(jié)論 1、對(duì)顏面輪廓各指標(biāo)定義進(jìn)行規(guī)范后,三維超聲評(píng)估胎兒顏面輪廓的觀察者內(nèi)及觀察者間一致性較好,臨床應(yīng)用中具有明顯優(yōu)勢(shì) 2、胎兒鼻骨長度及鼻前組織厚度與孕周密切相關(guān),隨孕周呈S曲線增長,鼻前組織厚度與鼻骨長度之比在整個(gè)孕周保持穩(wěn)定 3、正常胎兒顏面輪廓線無“陰性”表現(xiàn) 4、胎兒顏面角度變化與孕周相關(guān),曲線擬合三次多項(xiàng)式相關(guān)程度最高 目的 回顧分析染色體異常胎兒顏面輪廓的特點(diǎn),評(píng)估顏面輪廓相關(guān)指標(biāo)對(duì)染色體異常的提示價(jià)值 資料與方法 病例組選取2008年3月-2013年1月期間于我院進(jìn)行產(chǎn)科超聲檢查并有明確染色體結(jié)果的胎兒共26例,其中21-三體21例,18-三體5例。對(duì)照組隨機(jī)選取正常胎兒325例。 回顧分析胎兒顏面正中矢狀面圖像,聯(lián)合評(píng)估顏面輪廓的各項(xiàng)指標(biāo)：1..測(cè)量鼻骨長度(nasal bone length, NBL)、鼻前組織厚度(prenasal thickness,PT),并計(jì)算PT/NBL；2.確定顏面輪廓線(facial profile line,FPL)的三種分型,即零,陰性和陽性,陽性時(shí)測(cè)量FPL到額骨外緣的距離F；3.規(guī)范各顏面角度如額-上頜角(frontomaxillary facial angle,FMF)、額-鼻角(frontonasal angle,FNA)、上下頜面角(]mandibulomaxillary facial angle,MMF)、上頜-鼻根-下頜角(maxilla-nasion-mandible angle,MNM)的定義。 將上述顏面輪廓的各相關(guān)指標(biāo)與對(duì)照組正常胎兒各參考值范圍進(jìn)行對(duì)比分析,評(píng)估染色體異常胎兒與正常胎兒之間的差異。 結(jié)果 1、21-三體胎兒 21例21-三體胎兒中,11例鼻骨缺失,余10例胎兒的NBL與對(duì)照組正常胎兒無明顯差異(P0.05)。21-三體胎兒PT明顯增厚,平均值為5.67mm,與正常胎兒的平均值4.21mm存在顯著差異(P0.05),并且76.2%(16/21)高于正常胎兒第95百分位數(shù)。存在鼻骨的10例21-三體胎兒計(jì)算PT/NBL,平均值為1.21,明顯大于正常胎兒的平均值0.69(P0.05)。 21-三體胎兒FPL14例為“零”,4例“陽性”(F值0.23-0.55cm),3例“陰性”。3例FPL“陰性”的胎兒存在前額扁平。 21-三體胎兒與正常胎兒在FMF角與MNM角之間存在顯著差異(P0.05)。在21-三體胎兒中,95.2%(20/21)的FMF角大于正常胎兒的平均值,38.1%(8/21)大于正常胎兒的第95百分位數(shù)；85.7%(18/21)的MNM角小于正常胎兒的平均值。 2、18-三體胎兒5例18-三體胎兒中,NBL、PT及PT/NBL與正常胎兒無明顯差異(P0.05)。18-三體胎兒2例FPL為“零”,3例“陰性”,無“陽性”結(jié)果。3例FPL“陰性”的胎兒均存在小下頜。 18-三體胎兒與正常胎兒在MMF角與MNM角之間存在顯著差異(P0.05)。在18-三體胎兒中,100%(5/5)的MMF角小于正常胎兒的平均值,40%小于正常胎兒的第5百分位數(shù)；100%(5/5)的MNM角大于正常胎兒的平均值,40%大于正常胎兒的第95百分位數(shù)。 結(jié)論 1、顏面正中矢狀面可為篩查胎兒染色體異常提供多個(gè)信息,該切面應(yīng)作為中孕超聲篩查的常規(guī)內(nèi)容 2、鼻骨及鼻前組織厚度的測(cè)量對(duì)于21-三體的篩查意義明確,FMF及MNM角有助于提示顏面扁平,可作為篩查21-三體的輔助超聲標(biāo)記 3、MMF及MNM角可提示小下頜,對(duì)診斷18-三體具有一定意義 4、FPL可初步判斷胎兒前額及下頜異常
[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

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.5;R445.1
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本文編號(hào)：1814643