Risk of critical congenital heart defects by nuchal translucency norms
Risk of critical congenital heart defects by nuchal translucency norms
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DOI：
10.1016/j.ajog.2014.10.1102
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发表时间：
2015-04-01
影响因子：
9.8
通讯作者：
Currier, Robert J.
中科院分区：
文献类型：
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作者：
Jelliffe-Pawlowski, Laura L.;Norton, Mary E.;Currier, Robert J.
目的：本研究的目的是比较妊娠早期颈项透明层 (NT) 截止值 >= 3.5 mm 的性能与根据头臀长度计算的 NT 百分位，以识别患有严重先天性心脏缺陷 (CCHD) 的胎儿。 研究设计：这是一项针对加利福尼亚州单胎妊娠的人群水平研究，在妊娠 11 至 14 周之间进行 NT 测量。符合条件的病例是那些在 2009 年至 2010 年期间产生活产的病例，并且在 1 岁之前的出院记录中有关于是否存在 CCHD 的信息 (n = 76,089)。使用 Logistic 二项式回归方法通过头臀长和毫米切点的 NT 百分位来比较 CCHD 的发生率。 结果：与 NT 测量值 = 第 99 个百分位的胎儿相比，患有 CCHD 的可能性 >5 倍（1.3% vs 0.2%；相对风险，5.66；95% 置信区间，3.19-10.04）和 NT 测量值 >= 的胎儿3.5 mm 患 CCHD 的可能性是其 12 倍以上（2.8% vs 0.2%；相对风险，12.28；95% 置信区间，5.11-29.51）。 NT >= 99% 的 CCHD 检测灵敏度为 5.8%，特异性为 98.9%，而 NT >= 3.5 mm 的灵敏度为 2.6% 和 99.8%。结论：结果显示，>= 99% 和 >= 3.5 mm 的 NT 测量结果并不相同，CCHD 的重大风险延伸至限制性较小的 >= 99% 分界点。数据表明，与现行标准相比，使用此切点可能会使根据 NT 风险识别的 CCHD 数量增加一倍。
OBJECTIVE: The purpose of this study was to compare the performance of first-trimester nuchal translucency (NT) cutoff of >= 3.5 mm with NT percentiles that were calculated for crown-rump length to identify fetuses with critical congenital heart defects (CCHDs).STUDY DESIGN: This was a population-level study of singleton pregnancies in California with NT measurements performed between 11 and 14 weeks of gestation. Eligible cases were those that resulted in live births from 2009-2010 and had information about the presence or absence of CCHDs available in the hospital discharge records through age 1 year (n = 76,089). Logistic binomial regression methods were used to compare the rate of CCHDs by an NT percentile for crown-rump length and millimeter cutpoints.RESULTS: Compared with fetuses with an NT measurement of = 99th percentile were >5 times as likely to have a CCHD (1.3% vs 0.2%; relative risk, 5.66; 95% confidence interval, 3.19-10.04) and fetuses with an NT measurement >= 3.5 mm were > 12 times as likely to have a CCHD (2.8% vs 0.2%; relative risk, 12.28; 95% confidence interval, 5.11-29.51). NT >= 99th percentile had a sensitivity of 5.8% and a specificity of 98.9% for the detection of CCHDs compared with 2.6% and 99.8% for NT >= 3.5 mm.CONCLUSION: Results show that NT measurements of >= 99th percentile and >= 3.5 mm are not equivalent and that substantial risk for CCHD extends to the less restrictive >= 99th percentile cutpoint. Data suggest that the use of this cutpoint compared with the current standard could double the number of CCHDs that are identified based on NT risk.