超声心动图诊断法洛四联症的临床价值评估  

The accuracy,reliability and predictive value of echocardiography in the diagnosis of Tetralogy of Fal-lot

作　　者：张晓洁[1] 黄美蓉[1] 孙锟[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心内科,上海200127

出　　处：《临床儿科杂志》2007年第7期600-603,共4页Journal of Clinical Pediatrics

摘　　要：目的评价超声心动图诊断法洛四联症(TOF)的准确性、可靠性和效益,探讨法洛四联症无创伤性术前诊断方法及手术指征。方法以手术后诊断为金标准,评价234例TOF患儿的二维超声心动图(2-DE)诊断及心导管诊断结果。结果对于TOF的诊断,2-DE诊断灵敏度97.9%,特异度99.8%,符合率99.6%;心导管诊断灵敏度99.5%,特异度100%,符合率99.9%;两者的差异无统计学意义。在TOF合并心血管畸形的诊断中,2-DE诊断CA横跨ROVT、侧支血管、PDA的灵敏度、特异度、符合率与手术后诊断存在明显差异。结论2-DE可替代心导管造影检查用于TOF的诊断。如果术前2-DE检查发现冠状动脉显示不清或怀疑走行异常、存在侧支血管、PDA与侧支血管难以鉴别及肺动脉分支发育不良时,需进一步行心导管造影检查。Objectives To evaluate the accuracy, reliability and predictive value of echocardiography in the diagnosis of Tetralogy of Fallot （TOF） and its associated abnormalities and to explore the indications of cardiovascular operations without preoperative cardiac catheterization for children with TOF. Methods Using post-operative diagnosis as gold standard, we reviewed the records of two dimensional color Doppler echocardiography （2-DE） and cardiac catheterization of 234 children with TOF, who underwent primary operations between January 2003 and June 2004, Results The diagnostic sensitivity, specificity and reliability of echocardiography in the diagnosis of TOF were 97.9%, 99.8% and 99.6% compared with 99.5%, 100% and 99.9% for cardiac catheterization respectively. The differences between two groups were not statistically significant. While the diagnostic sensitivity, specificity and reliability of 2-DE were significantly lower than post-operative diagnosis for the diagnosis of associated abnormalities including coronary artery anomaly, collateral vessels or patent ductus arteriosus. Conclusions 2-DE could replace cardiac catheterization for the preoperative diagnosis of TOF. Cardiac catheterization is required when the presence of suspected abnormalities, including coronary artery anomaly of collateral vessels, uneasily defined PDA, collateral vessels, or poorly delineated branch pulmonary arteries is suggested by 2-DE.

关 键 词：超声心动图 法洛四联症 准确性 可靠性 预测值 

分 类 号：R725.4[医药卫生—儿科]