Diagnostic accuracy of nuchal translucency thickening combined with Tei index in fetal cardiac malformations in early pregnancy and impact factors of diagnostic accuracy
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摘要:
目的 研究超声检测颈部透明层（NT）增厚结合Tei指数对孕早期胎儿心脏畸形的诊断及诊断准确率影响因素。 方法 选择2015年1月~2020年2月在本院进行孕早期筛查的先天性疾病孕产妇108例作为研究对象，另选取同期进行孕检的正常产妇101例作为对照组，比较两组患者的NT以及Tei指数的差异，研究NT以及Tei指数联合诊断对于先天性心脏病的诊断效能，分析影响诊断准确率影响因素。 结果 观察组患者的NT（t=16.780，P < 0.001）和Tei指数（t=7.406，P < 0.001）高于对照组；NT以及Tei指数联合诊断对于先天性心脏病的诊断特异性显著高于单独检测，通过ROC曲线分析，NT以及Tei指数联合诊断的曲线下面积显著高于单独检测，同时通过临界值分析，对于先天性心脏病的诊断，NT的临界值为2.56 mm，Tei指数的临界值为0.51；准确诊断与假阳性以及假阴性患者的筛查时机、医生专业技能、胎儿体位之间的差异存在统计学意义（P < 0.05）；多因素分析显示，筛查时机、医生专业技能、胎儿体位均是造成患者假阳性以及假阴性的影响因素。 结论 超声检测NT增厚结合Tei指数对孕早期胎儿心脏畸形的诊断具有积极的意义，在诊断中，筛查时机较小、医生专业技能较低、胎儿体位不配合均是影响诊断准确率的影响因素。 Abstract:Objective To study the diagnostic of fetal cardiac malformations in early pregnancy by ultrasound detection of nuchal translucency (NT) thickening combined with Tei index and the factors influencing the diagnostic accuracy. Methods A total of 108 cases of pregnant women who underwent early pregnancy screening for congenital diseases in our hospital from January 2015 to February 2020 were selected as the research object. 101 cases of normal pregnant women who underwent pregnancy examination at the same time were selected as the control group. The differences in NT and Tei index between the two groups were compared to study the diagnostic efficacy of combined diagnosis of NT and Tei index for congenital heart disease and to analyse the factors influencing diagnostic accuracy. Results NT (t=16.780, P < 0.001) and Tei index (t=7.406, P < 0.001) in the observation group were significantly higher than those in the control group. The diagnostic specificity of combined diagnosis of NT and Tei index for congenital heart disease was significantly higher than that of individual tests, and the area under the curve of combined diagnosis of NT and Tei index was significantly higher than that of individual tests by ROC curve analysis. At the same time, through critical value analysis, for the diagnosis of congenital heart disease, the critical value of NT was 2.56 mm and the critical value of Tei index was 0.51. There were significant differences between the timing of screening, doctor's expertise and fetal position for accurate diagnosis and false-positive and false-negative patients (P < 0.05). The multifactorial analysis showed that the timing of screening, doctor's expertise and fetal position were all influential factors in the false positives and false negatives. Conclusion Ultrasonic detection of NT thickening combined with Tei index has positive implications for the diagnosis of fetal cardiac malformation in early pregnancy. In the diagnosis, the smaller timing of screening, the low expertise of the physician and lack of cooperation of the fetal position are all factors affecting the diagnostic accuracy. -
Key words:
- congenital heart disease /
- nuchal translucency /
- ultrasound /
- Tei index /
- joint detection
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表 1 两组患者的一般资料比较
Table 1. Comparison of general data between the two groups (Mean±SD)
组別 孕周(周） 年龄(岁） 产次(次） 观察组(n=108) 11.23±2.33 27.42±2.09 1.35±0.34 对照组(n=101) 11.44±2.43 27.71±2.43 1.42±0.32 t 0.637 0.922 1.533 P 0.525 0.358 0.127 
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表 2 两组的NT以及Tei指数比较
Table 2. Comparison of NT and Tei indexes between the two groups (Mean±SD)
组別 NT(mm) Tei 观察组(n=108) 2.74±0.33 0.54±0.22 对照组(n=101) 2.02±0.29 0.36±0.12 t 16.780 7.406 P < 0.001 < 0.001
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表 3 NT以及Tei指数联合诊断对于先天性心脏病的诊断效能分析
Table 3. Analysis of diagnostic efficacy of combined diagnosis of NT and Tei index for congenital heart disease
诊断方法 真阳例数
(n)假阳例数
(n)真阴例数
(n)假阴例数
(n)准确率
(%)敏感度
(%)特异性
(%)阳性预测值
(%)阴性预测值
(%)NT 93 25 76 15 80.86 86.11 44.97 78.81 83.52 Tei 91 20 81 17 82.30 84.26 47.09 81.98 82.65 联合检测 90 5 96 18 89.00 83.33 51.61 94.74 84.21
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表 4 ROC曲线分析
Table 4. ROC curve analysis [n(%)]
组别 准确诊断(n=186) 假阳、假阴(n=23) χ2 P 筛查时机(孕周） 4.662 0.031 < 10周 120(85.71) 20(14.29) >10周 66(95.65) 3(4.35) 医生专业技能 高级 91(94.79) 5(5.21) 6.092 0.014 非高级 95(84.07) 18(15.93) 胎儿体位 配合 80(95.24) 4(4.76) 5.592 0.018 非配合 106(84.80) 19(15.20)
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表 5 假阳性以及假阴性患者的单因素分析
Table 5. Univariate analysis of false positive and false negative patients[n(%)]
诊断方法 标准误 AUC AUC(95%CI) P NT 11.231 0.775 0.520~0.872 0.017 Tei 9.252 0.603 0.600~0.746 < 0.001 联合检测 12.230 0.823 0.126~0.996 < 0.001
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表 6 多因素分析
Table 6. Multi factor analysis
因索 β S.E. Wald P OR 95%CI 筛査时机(孕周） 1.018 2.361 1.322 0.001 1.019 1.009~1.926 医牛专业技能 1.062 3.269 1.333 0.002 1.632 1.331-2.320 胎儿休位 0.369 4.139 1.691 < 0.001 1.089 1.002~2.065
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