正常胎儿胸腺Z评分模型的研究

doi:10.12280/gjfckx.20211093

摘要/Abstract

摘要：

目的: 探讨胎儿胸腺横径、前后径、面积及周长随孕周增加的变化规律,建立20~38周正常胎儿胸腺Z评分模型。方法: 随机抽取2020年9月—2021年5月在河南中医药大学第三附属医院进行常规产检的单胎孕妇612例,测量胎儿胸腺横径、前后径、面积和周长,根据各测量值与孕周、双顶径（biparietal diameter,BPD）、股骨长的相关系数筛选评估胎儿胸腺大小的最佳指标,建立胎儿胸腺基于孕周、BPD、股骨长最佳预测回归方程和预测标准差（standard deviation,SD）回归方程,并根据公式Z=（胸腺实际测量值-预测值）/预测SD构建Z评分模型。结果: 胎儿胸腺横径、前后径、面积及周长的二维测量值均随着孕周的增加而增加,与孕周呈正相关（P<0.001）;其中胸腺横径与孕周的相关性最高（r=0.873,P<0.001）。胎儿胸腺横径与孕周、BPD、股骨长最佳拟合方程均为线性。成功建立了胎儿胸腺横径的预测回归方程和预测标准差回归方程,计算所得的Z值经Shapiro-Wilk检验均满足正态分布（P>0.05）。结论: 胸腺横径为评估正常胎儿胸腺大小的最佳二维指标,建立的胎儿胸腺横径的Z评分模型为产前评估胎儿胸腺发育情况及早发现胸腺发育异常相关疾病提供了依据。

关键词: 胎儿, 胸腺, 超声检查,产前, Z评分, 预测模型

Abstract:

Objective: To investigate the changes of fetal thymus transverse diameter, anterior and posterior diameter, area and circumference with gestational age (GA), and to establish the Z score model of normal fetal thymus from 20 to 38 weeks. Methods: From September 2020 to May 2021, 612 single pregnant women who underwent routine prenatal examinations in the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine were randomly selected. The transverse diameter, anterior and posterior diameter, area and circumference of the fetal thymus were measured. According to the correlation coefficients between the measured values and GA, biparietal diameter (BPD) and femur length (FL), the optimal indexes for evaluating fetal thymus size were selected. The optimal prediction regression equation and prediction standard deviation (SD) regression equation of fetal thymus were established based on GA, BPD and FL, and the Z-score model was constructed according to the formula Z value =(actual measured thymus value-predicted thymus value)/predicted SD. Results: The two-dimensional measurements of fetal thymus increased with the increase of GA, which was significantly positively correlated with GA (P<0.001). The correlation between thymus diameter and GA was the highest (r=0.873, P<0.001). The best fitting equations of fetal thymus diameter with GA, BPD and FL were linear. The predicted regression equation and the predicted standard deviation regression equation of fetal thymus diameter were established successfully, and the Z-values calculated by Shapiro-Wilk test satisfied normal distribution (P>0.05). Conclusions: Thymus transverse diameter is the best two-dimensional index to evaluate normal fetal thymus size, and the Z-score model of fetal thymus transverse diameter provides a basis for prenatal evaluation of fetal thymus development and early detection of diseases related to abnormal thymus development.

Key words: Fetus, Thymus gland, Ultrasonography,prenatal, Z-score, Prediction model

顾凯莉, 冯涛, 田力, 邓苗苗, 王丽琦. 正常胎儿胸腺Z评分模型的研究[J]. 国际妇产科学杂志, 2022, 49(3): 340-344.

GU Kai-li, FENG Tao, TIAN Li, DENG Miao-miao, WANG Li-qi. Study on Z-Score Model of Normal Fetal Thymus[J]. Journal of International Obstetrics and Gynecology, 2022, 49(3): 340-344.

图/表 9

参考文献 16

[1]	Sullivan KE. Chromosome 22q11.2 deletion syndrome and DiGeorge syndrome[J]. Immunol Rev, 2019, 287(1):186-201. doi: 10.1111/imr.12701. doi: 10.1111/imr.12701
[2]	Ekin A, Gezer C, Taner CE, et al. Prognostic Value of Fetal Thymus Size in Intrauterine Growth Restriction[J]. J Ultrasound Med, 2016, 35(3):511-517. doi: 10.7863/ultra.15.05039. doi: 10.7863/ultra.15.05039
[3]	Basaran OE, Guvendag Guven ES, Guven S. First trimester fetal thymus volume may predict preeclampsia[J]. Pregnancy Hypertens, 2021, 26:116-120. doi: 10.1016/j.preghy.2021.10.007. doi: 10.1016/j.preghy.2021.10.007 pmid: 34741882
[4]	南钰, 范丽梅, 王铎, 等. 胎儿胸腺测量与早期诊断妊娠期高血压疾病中的价值研究进展[J]. 中国妇幼保健, 2017, 32(5):1112-1115. doi: 10.7620/zgfybj.j.issn.1001-4411.2017.05.82. doi: 10.7620/zgfybj.j.issn.1001-4411.2017.05.82
[5]	Pittyanont S, Luewan S, Tongsong T. Cardio-STIC Based Reference Ranges of Fetal Thymus Size in Singleton Pregnancies[J]. J Ultrasound Med, 2017, 36(6):1181-1188. doi: 10.7863/ultra.16.07041. doi: 10.7863/ultra.16.07041 pmid: 28224652
[6]	Geenen V. The thymus and the science of self[J]. Semin Immunopathol, 2021, 43(1):5-14. doi: 10.1007/s00281-020-00831-y. doi: 10.1007/s00281-020-00831-y
[7]	Ghalandarpoor-Attar SN, Borna S, Ghalandarpoor-Attar SM, et al. Measuring fetal thymus size: a new method for diabetes screening in pregnancy[J]. J Matern Fetal Neonatal Med, 2020, 33(7):1157-1161. doi: 10.1080/14767058.2018.1517309. doi: 10.1080/14767058.2018.1517309 pmid: 30153759
[8]	Sciaky-Tamir Y, Hershkovitz R, Mazor M, et al. The use of imaging technology in the assessment of the fetal inflammatory response syndrome-imaging of the fetal thymus[J]. Prenat Diagn, 2015, 35(5):413-419. doi: 10.1002/pd.4560. doi: 10.1002/pd.4560
[9]	Kleemann S, Koch R, Schmitz R, et al. Correlation of first-trimester thymus size with chromosomal anomalies[J]. J Perinat Med, 2021, 49(5):604-613. doi: 10.1515/jpm-2020-0599. doi: 10.1515/jpm-2020-0599 pmid: 33561911
[10]	Tangshewinsirikul C, Panburana P. Sonographic measurement of fetal thymus size in uncomplicated singleton pregnancies[J]. J Clin Ultrasound, 2017, 45(3):150-159. doi: 10.1002/jcu.22419. doi: 10.1002/jcu.22419 pmid: 27862004
[11]	李伯义, 凌乐文, 吕国荣. 产前高分辨力超声检测正常胎儿胸腺的方法及临床意义[J]. 中国医学影像技术, 2011, 27(2):361-363. 10.13929/j.1003-3289.2011.02.029. doi: 10.13929/j.1003-3289.2011.02.029
[12]	Myers R, Hutter J, Matthew J, et al. Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 264:1-7. doi: 10.1016/j.ejogrb.2021.06.026. doi: 10.1016/j.ejogrb.2021.06.026
[13]	Tonni G, Rosignoli L, Cariati E, et al. Fetal thymus: visualization rate and volume by integrating 2D- and 3D-ultrasound during 2nd trimester echocardiography[J]. J Matern Fetal Neonatal Med, 2016, 29(14):2223-2228. doi: 10.3109/14767058.2015.1081892. doi: 10.3109/14767058.2015.1081892
[14]	冯涛, 田力, 王珂宁, 等. 构建正常胎儿超声心动图动脉导管Z评分模型[J]. 中国医学影像技术, 2021, 37(8):1182-1185. doi: 10.13929/j.issn.1003-3289.2021.08.015. doi: 10.13929/j.issn.1003-3289.2021.08.015
[15]	金莹, 徐冉, 周启昌, 等. 孕中晚期正常胎儿双肾体积Z-评分研究[J]. 中华超声影像学杂志, 2020, 29(6):483-488. doi: 10.3760/cma.j.cn131148-20200109-00019. doi: 10.3760/cma.j.cn131148-20200109-00019
[16]	Zych-Krekora K, Krekora M, Słodki M, et al. Nomograms of the fetal thymus for clinical practice[J]. Arch Med Sci, 2019, 17(6):1657-1662. doi: 10.5114/aoms.2019.86189. doi: 10.5114/aoms.2019.86189

参数	回归方程	相关系数（r）	决定系数（R²）	F	P
横径	Ŷ=0.109×孕周-0.570	0.873	0.762	1 952.164	<0.001
前后径	Ŷ =0.056×孕周-0.389	0.793	0.629	1 036.009	<0.001
面积	Ŷ =0.224×孕周-3.639	0.826	0.683	1 312.565	<0.001
周长	Ŷ =0.293×孕周-1.176	0.815	0.665	1 210.463	<0.001

参数	回归方程	相关系数（r）	决定系数（R²）	F	P
横径	Ŷ=0.109×孕周-0.570	0.873	0.762	1 952.164	<0.001
前后径	Ŷ =0.056×孕周-0.389	0.793	0.629	1 036.009	<0.001
面积	Ŷ =0.224×孕周-3.639	0.826	0.683	1 312.565	<0.001
周长	Ŷ =0.293×孕周-1.176	0.815	0.665	1 210.463	<0.001

参数	回归方程	相关系数（r）	决定系数（R²）	F	P
横径	Ŷ =0.042×BPD-0.450	0.868	0.753	1 859.771	<0.001
前后径	Ŷ =0.021×BPD-0.339	0.794	0.631	1 041.447	<0.001
面积	Ŷ =0.086×BPD-3.469	0.831	0.691	1 364.798	<0.001
周长	Ŷ =0.111×BPD-0.829	0.808	0.653	1 148.601	<0.001

参数	回归方程	相关系数（r）	决定系数（R²）	F	P
横径	Ŷ =0.042×BPD-0.450	0.868	0.753	1 859.771	<0.001
前后径	Ŷ =0.021×BPD-0.339	0.794	0.631	1 041.447	<0.001
面积	Ŷ =0.086×BPD-3.469	0.831	0.691	1 364.798	<0.001
周长	Ŷ =0.111×BPD-0.829	0.808	0.653	1 148.601	<0.001

参数	回归方程	相关系数（r）	决定系数（R²）	F	P
横径	Ŷ =0.051×股骨长-0.130	0.869	0.755	1 881.858	<0.001
前后径	Ŷ =0.026×股骨长-0.147	0.781	0.609	951.243	<0.001
面积	Ŷ =0.105×股骨长-2.772	0.828	0.686	1 332.465	<0.001
周长	Ŷ =0.138×股骨长-0.048	0.819	0.653	1 238.176	<0.001