摘要目的 初步探讨产前超声定量测量胎儿气管与双侧支气管角度诊断异构综合征的可行性,为产前诊断异构综合征寻找新的诊断依据. 方法 对2015年10月至201 8年12月于重庆市妇幼保健院产前超声检查正常胎儿(孕18～34周+6)200例(正常组)及产前超声检查并经(引)产后证实的异构综合征胎儿41例(病例组)进行回顾性分析,收集支气管冠状切面气管与双侧支气管角度的测量数据,其中右房异构综合征35例(右房异构组),左房异构综合征6例(左房异构组),绘制正常组及病例组左侧/右侧支气管角度(α/β)比值散点图,将正常组及病例组各组间及病例组组内双侧支气管角度α、β进行统计学分析,统计学方法采用单因素方差分析及配对t检验. 结果 正常组胎儿左侧/右侧支气管角度(α/β)比值散点图显示α/β值恒定在0.8～1.0,β＞α(t=-33.14,P＜0.05),均显示右侧支气管走行较左侧走行陡直.病例组散点图显示左房异构组和右房异构组胎儿α/β值均恒定在1.0左右.右房异构组胎儿α值增大且与β值接近[(153.90±5.43)°与(156.02±5.59)°,t=-2.56,P＞0.05],但差异无统计学意义,表现为双侧右支气管形态;左房异构组胎儿β值变小且与α值接近[(147.38±3.16)°与(148.82±5.56)度,t=-1.18,P＞0.05],表现为双侧左支气管形态.正常组、右房异构组、左房异构组各组间α、β值分别进行两两比较,差异均有统计学意义(P值均＜ 0.05),右房异构组α、β值均大于左房异构组(P值均＜ 0.05). 结论 产前超声测量胎儿支气管冠状切面气管与双侧支气管角度可以尝试作为诊断异构综合征的一种间接指标.

abstractsObjective To analyze the feasibility of prenatal ultrasound quantitative measurement of the angles between trachea and bilateral bronchi as a new diagnostic tool for fetuses with heterotaxy syndrome.Methods The angles between trachea and bilateral bronchi were measured at 18-34+6 gestational weeks for 200 fetuses with normal ultrasound findings (normal group) and 41 fetuses with heterotaxy syndrome [35 right atrial isomerisms (right group) and six left atrial isomerisms (left group)] diagnosed by ultrasound and confirmed after abortion or induction (case group) in Chongqing Health Center for Women and Children from October 2015 to December 2018.Scatter plots of left/right bronchus angle (α / β) ratios were drawn.Differences in bilateral bronchus angles between the three groups were statistically analyzed using one-way analysis of variance and paired t-test.Results In the normal group,scatter plots showed the α/β ratios were relatively constant at 0.8-1.0 with larger β than α (t=-33.14,P＜0.05),indicating that the right bronchus always went more steeply than the left one.In the case group,the α/β ratios were around 1.0.In the right group,the α value increased and was close to the β value [(153.90±5.43) ° vs (156.02±5.59) °,t=-2.56,P＞0.05] and presented as bilateral right bronchial angle;in the left group,the β value decreased and was close to the α value [(147.38±3.16)° vs (148.82±5.56) °,t=-1.18,P＞0.05] and presented as bilateral left bronchial angle.There were significant differences in the α and β values among the normal group,the right and left groups (all P＜0.05),and the bronchial angles of the right group were both greater than those of the left group (all P＜0.05).Conclusions Prenatal ultrasound measurement of the angles between trachea and bilateral bronchi can be used as an indirect indicator for the diagnosis of heterotaxy syndrome.