106例胎儿颈项透明层增厚(NT)的超声与遗传学产前诊断结果对照分析
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1.南京市妇幼保健院;2.南京市妇幼保健院遗传医学中心

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国家自然科学基金82101943


A comparative study of ultrasound and genetic prenatal diagnosis in 106 NT-thickened fetuses
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    摘要:

    摘 要 目的:探讨产前超声提示胎儿颈项透明层(NT)增厚的临床价值,并与遗传学产前诊断结果对比分析。方法:对我院106例胎儿NT 增厚的超声与遗传学产前诊断结果对比分析(所有胎儿均行染色体微阵列分析,其中有4例进行了全外显子测序,1例行SMN1 基因检测),并跟踪妊娠结局。结果:共发现44(41.51%)例遗传学异常,2例临床意义不明性拷贝数变异。遗传学异常中共包含39例染色体异常(34例非整倍体异常和5例为致病性拷贝数变异)及5例基因异常(均为致病性或可能致病性变异)。随着NT厚度的增加,遗传学异常的发生率明显升高。此外,44例遗传学异常胎儿中有38例(86.36%)合并其它超声异常,其中鼻骨发育不良占比最高。结论:胎儿NT增厚时遗传学异常的发生率显著增加,发现胎儿NT增厚应首先考虑染色体异常尤其是非整倍体异常。NT增厚还与拷贝数变异及某些单基因遗传病有关。对于染色体微阵列阴性的NT增厚胎儿,可结合超声及家族史等综合考虑行全外显子检测。

    Abstract:

    Abstract Objective: To explore the clinical value of prenatal ultrasound in suggesting thickening of the nuchal translucency in the fetus and to compare the results with those of genetic prenatal diagnosis. Methods: The results of ultrasound and genetic prenatal diagnosis of 106 fetuses with thickening of the nuchal translucency at our institution were compared and analyzed (all fetuses were subjected to chromosomal microarray analysis, with whole-exome sequencing in four cases and SMN1 gene testing in one case), and pregnancy outcomes were followed. Results: A total of 44 (41.51%) cases of genetic abnormalities and 2 cases of copy number variants of unknown clinical significance were identified. A total of 39 chromosomal abnormalities (34 aneuploidy abnormalities and 5 pathogenic copy number variants) and 5 genetic abnormalities (all pathogenic or suspected pathogenic variants) were included in those with genetic abnormalities. The incidence of genetic abnormalities increased significantly with increasing thickness of the nuchal translucency. In addition, 38 (86.36%) of 44 fetuses with genetic abnormalities were combined with other ultrasound abnormalities, with the highest percentage of nasal bone dysplasia.Conclusions: The incidence of genetic abnormalities is significantly increased in thickened nuchal translucency, and chromosomal abnormalities, especially aneuploidy, should be the first consideration in the detection of thickened nuchal translucency. NT thickening is also associated with copy number variation and certain monogenic inherited diseases . For Chromosome microarray analysis negative NT thickening fetus, can be combined with ultrasound and family history of comprehensive to thewhole-exome sequencing.

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  • 收稿日期:2024-03-04
  • 最后修改日期:2024-05-19
  • 录用日期:2024-07-04
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