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浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (4): 434-438    DOI: 10.3785/j.issn.1008-9292.2019.08.14
    
Prognosis of fetuses with cystichygroma and nuchal translucency/nuchal fold thickening on prenatal echography
WANG Yayun(),CHEN Yuan,YANG Mengmeng,XI Fangfang,ZHAN Qitao,JIANG Ying,ZHAO Baihui,LUO Qiong*()
Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
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Abstract  

Objective: To analyze the prognosis of fetuses with cystic hygroma (CH) or nuchal translucency (NT) or nuchal fold (NF) thickening detected by prenatal echography. Methods: From January 2014 to December 2015, 124 fetuses with CH and NT/NF thickening on prenatal echography were enrolled from Women's Hospital of Zhejiang University School of Medicine. The basic clinical information, ultrasonic results, pregnancy outcomes and newborn follow-ups were analyzed. The cases were grouped by prognosis and the factors affecting prognosis were analyzed with logistic regression. Results: There were 85 cases of labor induction including one stillbirth and 39 cases delivered. Except one infant who died after birth, all live births survived with good prognosis. Univariate analysis showed that the gestational age at diagnosis of poor prognosis group was earlier than that of good prognosis group (P < 0.01); and the former group also had higher hydrops fetalis rate and additional structural anomalies rate (all P < 0.01). Multivariate regression analysis showed that hydrops fetalis (OR=90.105, P < 0.05) and additional structural anomalies (OR=61.854, P < 0.05) were risk factors of poor prognosis in fetuses with CH and NT/NF thickening. Conclusions: Fetuses with diagnosed CH or NT/NF thickening on prenatal ultrasonography are likely to be associated with chromosomal abnormality. Early gestational weeks, hydrops fetalis and additional structural anomalies may indicate poor prognosis.

Key words： Lymphangioma, cystic/diagnostic imaging      Hydropsfetalis      Aneuploidy      Chromosomes      Nuchal translucency measurement      Ultrasonography, prenatal      Prognosis     
Received: 04 April 2019      Published: 30 October 2019
CLC:  R714.5  
  R715  
Corresponding Authors: LUO Qiong     E-mail: yayu.wang@outlook.com;luoq@zju.edu.cn
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WANG Yayun
CHEN Yuan
YANG Mengmeng
XI Fangfang
ZHAN Qitao
JIANG Ying
ZHAO Baihui
LUO Qiong
Cite this article:

WANG Yayun,CHEN Yuan,YANG Mengmeng,XI Fangfang,ZHAN Qitao,JIANG Ying,ZHAO Baihui,LUO Qiong. Prognosis of fetuses with cystichygroma and nuchal translucency/nuchal fold thickening on prenatal echography. J Zhejiang Univ (Med Sci), 2019, 48(4): 434-438.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.08.14     OR     http://www.zjujournals.com/med/Y2019/V48/I4/434


淋巴水囊瘤或颈部组织增厚胎儿预后分析

目的: 分析淋巴水囊瘤或颈部组织增厚胎儿预后的影响因素。方法: 回顾性分析2014年1月至2015年12月浙江大学医学院附属妇产科医院产前诊断中心收治的124例胎儿淋巴水囊瘤及颈部组织增厚病例，记录其临床基本信息及超声检查结果，并通过随访了解其妊娠结局。比较预后良好组与预后不良组的差异，并采用二分类逻辑回归分析法分析预后的影响因素。结果: 所有病例中，85例选择终止妊娠引产，包括1例引产前已发生胎死宫内，39例最终分娩，除1例出生后放弃抢救死亡，其余均存活并预后良好。单因素分析结果显示，预后不良组中发现胎儿异常的孕周[（18.7±4.1）周]小于预后良好组[（27.9±4.3）周]（P < 0.01）；预后不良组胎儿全身水肿、其他结构异常的比例升高（均P < 0.01）。多因素回归分析结果显示，合并胎儿水肿者预后不良的风险约为未合并水肿者的90.105倍（P < 0.05），合并其他结构性异常者预后不良的风险约为未合并结构性异常者的61.854倍（P < 0.05）。结论: 胎儿淋巴水囊瘤及颈部组织增厚与胎儿染色体异常存在相关性。这类异常出现的孕周早、合并胎儿水肿或其他结构异常可能意味预后不良。


关键词： 淋巴管瘤, 囊状/影像诊断,  胎儿水肿,  非整倍性,  染色体,  颈部透明带检查,  超声检查, 产前,  预后 
序号 孕周
(周)		 超声诊断 染色体检查结果
1 25 颈项透明层增厚 特纳综合征(45，XO)
2 17 颈部淋巴水囊瘤、胎儿水肿、胚外体腔未闭 基因片段重复或缺失
3 15 颈项透明层增厚、侧脑室增宽、鼻骨发育不良 21三体综合征
4 17 颈部淋巴水囊瘤、侧脑室增宽、透明隔腔不明显 21三体综合征
5 13 颈部淋巴水囊瘤、胎儿水肿 18三体综合征
6 28 颈部淋巴水囊瘤、胎儿水肿 特纳综合征(45，XO)
7 14 颈部淋巴水囊瘤、胎儿水肿、胚外体腔未闭 特纳综合征(45，XO)
8 18 颈部淋巴水囊瘤、胎儿水肿 基因片段重复或缺失
Tab 1 Ultrasound diagnosis and chromosome examination results for cases of chromosomal abnormality
[$\bar x \pm s$或n(%)]
组别 n 孕周
(周)		 年龄
(岁)		 淋巴水囊瘤类型 合并全身水肿 合并其他结构异常
分隔型 非分隔型
“—”无相关资料.
预后良好组 38 27.9±4.3 28.5±4.5 19(50.0) 19(50.0) 1(2.6) 3(7.9)
预后不良组 20 18.7±4.1 27.7±5.0 11(55.0) 9(45.0) 6(30.0) 17(85.0)
t/χ2值 — 7.973 0.566 0.032 26.951 30.409
P值 — ＜0.01 ＞0.05 ＞0.05 ＜0.01 ＜0.01
Tab 2 Univariate analysis results on cystic hygroma and nuchal translucency/nuchal fold thickening grouped by prognosis
变量 回归系数 标准误差 比值比 P值
“—”无相关数据.
(截距) 10.200 10.352 — ＞0.05
孕周 -0.446 0.320 0.640 ＞0.05
年龄 -0.082 0.181 0.921 ＞0.05
分隔型淋巴水囊瘤 -0.587 1.722 0.556 ＞0.05
胎儿水肿 4.501 2.051 90.105 ＜0.05
其他结构异常 4.125 1.757 61.854 ＜0.05
Tab 3 Logistic regression estimation on prognostic factors of fetuses with cystic hygroma and nuchal translucency/nuchal fold thickening
[1]   FISHER R , PARTINGTON A , DYKES E . Cystic hygroma:comparison between prenatal and postnatal diagnosis[J]. J Pediatr Surg, 1996, 31 (4): 473- 476
doi: 10.1016/S0022-3468(96)90477-7
[2]   CHEN C P , LIU F F , JAN S W et al. Cytogenetic evaluation of cystic hygroma associated with hydrops fetalis, oligohydramnios or intrauterine fetal death:the roles of amniocentesis, postmortem chorionic villus sampling and cystic hygroma paracentesis[J]. Acta Obstet Gynecol Scand, 1996, 75 (5): 454- 458
doi: 10.3109/00016349609033353
[3]   孙瑜, 杨慧霞 . 胎儿颈部淋巴水囊瘤的预后[J]. 中华围产医学杂志, 2017, 20 (3): 170- 171
SUN Yu , YANG Huixia . Prognosis of fetal nuchal cystic hygroma[J]. Chinese Journal of Perinatal Medicine, 2017, 20 (3): 170- 171
[4]   ROSATI P , GUARIGLIA L . Prognostic value of ultrasound findings of fetal cystic hygroma detected in early pregnancy by transvaginal sonography[J]. Ultrasound Obstet Gynecol, 2000, 16 (3): 245- 250
doi: 10.1046/j.1469-0705.2000.00223.x
[5]   GIACALONE P L , BOULOT P , DESCHAMPS F et al. Prenatal diagnosis of cavernous lymphangioma of the arm[J]. Ultrasound Obstet Gynecol, 1993, 3 (1): 48- 50
doi: 10.1046/j.1469-0705.1993.03010048.x
[6]   SCHILD R L , ORHAN Y , MEYBERG H et al. Three-dimensional ultrasound of a massive fetal lymphangioma involving the lower extremity[J]. Ultrasound Obstet Gynecol, 2003, 22 (5): 547- 549
doi: 10.1002/uog.915
[7]   TANRIVERDI H A , ERTAN A K , HENDRIKH J et al. Outcome of cystic hygroma in fetuses with normal karyotypes depends on associated findings[J]. Eur J Obstet Gynecol Reprod Biol, 2005, 118 (1): 40- 46
doi: 10.1016/j.ejogrb.2004.04.005
[8]   GANAPATHY R , GUVEN M , SETHNA F et al. Natural history and outcome of prenatally diagnosed cystic hygroma[J]. Prenat Diagn, 2004, 24 (12): 965- 968
doi: 10.1002/pd.991
[9]   BRONSHTEIN M , BAR-HAVA I , BLUMENFELD I et al. The difference between septated and non-septated nuchal cystic hygroma in the early second trimester[J]. Obstet Gynecol, 1993, 81 (5(Pt 1)): 683- 687
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