糖尿病孕妇胎儿心脏超声检查的临床意义探讨  

Fetal echocardiography in diabetic and clinical significance

作　　者：于敏 李辉[2] 施展[2] 刘明颖[2] 

机构地区：[1]盘锦市第二人民医院超声科,盘锦124000 [2]中国医科大学附属盛京医院妇产科,沈阳110004

出　　处：《中国优生与遗传杂志》2008年第3期83-84,共2页Chinese Journal of Birth Health & Heredity

基　　金：2005年辽宁省重大科技攻关项目;项目号2005225008

摘　　要：目的探讨糖尿病孕妇引起胎儿心脏畸形发生率及胎儿心脏检查的意义。方法选自197例糖尿病孕妇(I型糖尿病6例,II型糖尿病19例,妊娠期糖尿病172例)。应用Yagel等描述的胎儿心脏检查方法进行胎儿心脏结构检查,并对产前诊断为先天性心脏畸形要求引产的胎儿进行尸体解剖核对产前诊断的正确性,并进行胎儿染色体分析;对未引产或产前诊断未发现明显异常胎儿进行临床随访,胎儿出生后进行新生儿或婴儿心脏超声检查,判定产前诊断的正确性。结果1·197例糖尿病孕妇中,5例(2·54%)被发现胎儿心脏畸形,其中1例来自于I型糖尿病患者(1/6,16·7%),2例来自于II型糖尿病患者(2/19,10·5%),2例来自于妊娠期糖尿病患者(2/172,1·16%)。2.5例胎儿心脏畸形具体类型及染色体核型如下:2例为法洛四联症(其中1例为21三体,1例染色体正常),1例为右室双出口(染色体正常),1例为室间隔缺损(21三体),1例为左心发育不良(染色体正常)。3.192例产前未发现胎儿心脏畸形胎儿,在分娩后的随访中,发现1例为室间隔缺损(直径为3mm,染色体正常);1例为动脉导管未闭。4.在胎儿心脏异常中,染色体异常发生率为28·6%。结论1·糖尿病孕妇具有导致子代心脏的高风险,建议对糖尿病孕妇进行胎儿心脏检查,进一步排除胎儿心脏畸形。2·I型糖尿病和II型糖尿病引起后代出现胎儿先天性心脏畸形的几率明显高于妊娠期糖尿病孕妇,在围孕期和妊娠早期进行良好的血糖控制。3·对糖尿病同时合并胎儿心脏畸形患者,如果需要继续妊娠,建议行羊膜腔穿刺或脐静脉穿刺排除胎儿染色体病变。Objective ： To investigate incidence of fetal congenital heart disease in diabetes and clinical significance of fetal echocardiography. Methods： 197 pregnancies with an echogenic intracardiac focus in the fetal heart were included in this study, Blood sample from umbilical vein or amniotic fluid sample from amniocentesis was used to evaluate fetal chromosome. A fetal echocardiography was performed for these cases. Results： 1. 42 cases with an echogenic intracardiac focus in the fetal heart accompanying other high risks for chromosome abnormalities at the same time. 174 cases were isolated an echogenic intracardiac focus in,the fetal heart. 2. Two cases were found fetal heart malformation in this population, one was tetralogy of Fallot with 21 trisomy, one was ventricular septal defect. Both of them were in high risks for chromosome abnormalities group. 3. Three cases were found 21 trisomy and all of them were in high risks for chromosome abnormalities group. One case was found an inverse position of chromosome No. 9 in isolated echogenic intracardiac focus group .（ the chromosome is same as her mother） . Conclusion： 1. An isolated echogenic intracardiac focus in the fetal heart is not associated with increased risk for chromosome abnormalities. 2. An echogenic intracardiae focus in the fetal heart with other high risk factors increased the risk for chromosome abnormalities and heart malformation.

关 键 词：糖尿病 心脏 畸形 胎儿 超声 

分 类 号：R445.1[医药卫生—影像医学与核医学]