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目的探讨胎儿脾动脉收缩期峰值流速(Sp A-PSV)预测重型α-地中海贫血(简称α-地贫)的临床意义。方法2012年1月至2014年1月在广东省妇幼保健院门诊检查的孕妇,采用彩色多普勒超声检测单胎孕18~39周共607例胎儿的Sp A-PSV值,正常组457例,观察组150例。正常组孕中期196例,孕晚期261例;观察组根据α-地贫基因类型分为非重型组105例与重型组45例,其中非重型组孕中期96例,孕晚期9例;重型组孕中期32例,孕晚期13例。采用两因素方差分析组别及孕期的主效应和交互效应。结果正常组、非重型组、重型组的主效应差异有统计学意义(F=18.832,P<0.001),孕期的主效应具有统计学意义(F=96.374,P<0.001),组别与孕期的交互效应也具有统计学意义(F=4.664,P=0.010)。正常组中,不同孕期Sp A-PSV的差异有统计学意义(t=13.549,P<0.001);非重型组中,不同孕期的差异也有统计学意义(t=19.117,P<0.001);重型组中,不同孕期的差异同样有统计学意义(t=6.663,P<0.001)。孕中期,3组间Sp A-PSV的差异有统计学意义(F=8.294,P<0.001),两两比较,重型组[(30.97±4.32)cm/s]相比正常组[(26.02±9.01)cm/s]和非重型组[(24.71±4.41)cm/s]Sp A-PSV值显著增高,差异有统计学意义(P<0.05),正常组相比非重型组差异无统计学意义。孕晚期,Sp A-PSV值3组间差异有统计学意义(F=10.440,P<0.001),重型组[(53.26±9.77)cm/s]相比正常组[(38.34±10.11)cm/s]和非重型组[(34.92±0.86)cm/s]Sp A-PSV值显著增高,差异有统计学意义(P<0.05),正常组相比非重型组差异无统计学意义。结论重型α-地贫胎儿在孕中晚期的Sp A-PSV值相比非重型α-地贫、正常胎儿均显著升高,提示超声多普勒测量Sp A-PSV值预测重型α-地中海贫血具有临床意义,为临床上筛查或监测重型α-地贫胎儿值得推荐的一种非侵入性方法。
Objective To investigate the clinical significance of Sp A-PSV in predicting severe a-thalassemia (a-thalassemia). Methods From January 2012 to January 2014 in Guangdong MCH clinic, Sp A-PSV was detected in 607 fetuses with singleton pregnancies from 18 to 39 weeks by color Doppler ultrasound. In the normal group, 457 cases , Observation group 150 cases. In the normal group, 196 cases were in the second trimester of pregnancy and 261 cases in the third trimester. According to the type of α-thalassemia gene, the observation group was divided into 105 cases of non-severe group and 45 cases of severe group, 96 cases of non-severe group in the second trimester and 9 cases of the third trimester. The second trimester of 32 cases, 13 cases of late pregnancy. The two-factor analysis of variance group and the main effect during pregnancy and interaction. Results The main effect of normal group, non-heavy group and heavy group was statistically significant (F = 18.832, P <0.001), the main effect of pregnancy was statistically significant (F = 96.374, P <0.001) The interaction effect was also statistically significant (F = 4.664, P = 0.010). In normal group, the difference of Sp A-PSV in different pregnancy was statistically significant (t = 13.549, P <0.001); in non-heavy group, the difference in different pregnancy was also statistically significant (t = 19.117, P <0.001) In the group, differences in different gestations were also statistically significant (t = 6.663, P <0.001). In the second trimester, the difference of Sp A-PSV between the three groups was statistically significant (F = 8.294, P <0.001). Compared with the normal group [(30.97 ± 4.32) cm / s] 9.01 cm / s] and Sp A-PSV in non-severe group [(24.71 ± 4.41) cm / s] were significantly higher than those in non-severe group significance. Compared with the normal group [(38.34 ± 10.11) cm / s], the Sp A-PSV value in the third trimester was significantly lower than that in the normal group (F = 10.440, s and non-severe group (34.92 ± 0.86 cm / s) Sp A-PSV were significantly increased, the difference was statistically significant (P <0.05), no significant difference between normal group and non-heavy group. Conclusions The Sp A-PSV value in the second trimester of pregnant women with severe α-thalassemia is significantly higher than that of non-heavy α-thalassemia and normal fetuses, suggesting that the Sp A-PSV value of Doppler ultrasound is used to predict severe α-thalassemia It is clinically meaningful and is a non-invasive method recommended for clinical screening or monitoring of severe alpha-thalassemia.