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目的探讨三维超声测量胎盘体积预测胎儿纯合型α0-地中海贫血(Hb-Bart’s病)的应用价值。方法在2002年6月～2004年5月期间对孕9～12周有α0-地中海贫血风险的胎儿组和正常对照组的单胎妊娠进行前瞻性研究。受累胎儿指二维超声检查提示α0-地中海贫血,并通过DNA检测证实的胎儿。胎盘体积通过三维超声扫描技术测量。同时评估操作者内和操作者间的测量结果的一致性。比较受累胎儿和正常对照组的胎盘体积-头臀长比值。结果最终研究对象包括105名孕妇,其中43名为α0-地中海贫血高危组,62名为正常对照组。有11名(10.5%)胎儿确定患有α0-地中海贫血,均来自高危组,其余均为正常胎儿。三维超声测量胎盘体积的操作者内和操作者间的测量结果一致性相对较差,这主要表现在一致性的变异范围较大(-10.82～40.86mL)。受累妊娠组的胎盘体积-头臀长比值的平均值±标准差(1.37±0.65)大于未受累妊娠组(1.13±0.39),但这个差异无统计学意义(P>0.05)。结论在孕早期通过三维超声测量胎盘体积来预测α0-地中海贫血并不优于二维超声。
Objective To investigate the value of three-dimensional ultrasound in the measurement of placental volume to predict fetal homozygous α0-thalassemia (Hb-Bart’s disease). Methods From June 2002 to May 2004, we prospectively studied singleton pregnancies in fetuses at risk of α0-thalassemia from 9 to 12 weeks gestation and normal controls. Affected fetus refers to two-dimensional ultrasound examination of α0-thalassemia and confirmed by fetal DNA test. Placenta volume is measured by three-dimensional ultrasound scanning technique. Simultaneous evaluation of operator and operator agreement between measurements. The placenta volume-head-to-hip ratio was compared between the fetuses and the normal controls. Results The final study included 105 pregnant women, of whom 43 were high-risk groups of α0-thalassemia and 62 were normal controls. Eleven (10.5%) fetuses were identified as having α0-thalassemia, both from high-risk groups and the rest from normal fetuses. Three-dimensional ultrasound measurements of placental volume within the operator and the consistency between the measured results of the relatively poor, mainly in the larger range of consistency of variation (-10.82 ~ 40.86mL). The mean ± standard deviation (1.37 ± 0.65) of placental volume to head-to-hip length ratio of pregnant women was significantly higher than that of non-pregnant women (1.13 ± 0.39), but the difference was not statistically significant (P> 0.05). Conclusion Prediction of α0-thalassemia by three-dimensional sonography in the early trimester of pregnancy is not superior to two-dimensional ultrasound.