Z－评分在胎儿主动脉狭窄诊断中的应用  

Application of Z-scores in the diagnosis of fetal aortic stenosis

作　　者：童小贞 赵博文[1] 王蓓[1] 潘美[1] 彭晓慧[1] 陆红妤[1] 陈剑[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,浙江大学邵逸夫临床医学研究所,杭州310016 [2]浙江省义乌市妇幼保健院超声科

出　　处：《中华超声影像学杂志》2015年第9期774-778,共5页Chinese Journal of Ultrasonography

基　　金：浙江省科技厅公益性技术应用研究计划项目（2012C33123）

摘　　要：目的探讨正常胎儿与主动脉狭窄（AS）胎儿主动脉内径Z－评分、主动脉／肺动脉内径比值的差异及Z一评分在AS诊断中的应用价值。方法采用彩色多普勒超声心动图对300例孕龄为16～40周的正常胎儿进行研究，测量收缩末期主动脉瓣环内径（A0）及肺动脉瓣环内径（PA）。以双顶径（BPD）、股骨长径（FL）作为自变量，AO、PA作为应变量建立最佳模型，并分析标准差（SD）与自变量BPD及FL的相关性，计算正常胎儿AO及PA的Z－评分。对106例孕龄为15～40周的AS胎儿进行研究，通过上述回归方程计算AS胎儿AO、PA的Z－评分，计算PA／A0值，与正常胎儿进行统计学比较。分别根据AO Z－评分、PA／A0值及AO百分范围同时计算AS的诊断准确性。结果两组AOZ-评分及PA／A0值差异有统计学意义（P〈0．01），PAZ一评分差异无统计学意义（P〉0．05）。AS组96．2％胎儿的AO Z－评分〈一3，95．3％AS胎儿PA／A0值分布于95％置信区间之外。AOZ－评分对AS的诊断准确性最高，阳性预测值为89．5％，阴性预测值为98．6％，灵敏性为96．2％，特异性为96％，约登指数为0．9223。PA／A0值次之，百分范围的最低。结论胎儿AO Z－评分位于±3之外与PA／AO值增大（〉1．4）相结合，在AS的诊断中具有重要的临床应用价值，较百分范围更能准确地定量评估AS胎儿心脏结构的生长发育。Objective To explore the difference in Z-score reference range for aorta measurements, and pulmonary artery（PA）/aortic（AO） valve annular diameter ratio（PA/AO ratio） between normal and aortic stenosis（AS） fetuses and to evaluate the diagnostic value of Z-score of aorta in fetuses with AS. Methods A retrospective cross-sectional study of fetal color Doppler echocardiograms were undertook from 300 singleton normal fetuses with gestational age ranged from 16 to 40 weeks. Standardized fetal echocardiographic measurements included AO valve annular diameter and PA valve annular diameter at end- systole,and PA/AO ratio were obtained. With statistical analysis,best model was established for predicting AO and PA using biparietal diameter （BPD） and femoral length （FL） as independent variables. The correlations between standard deviation （SD） and two independent variables （BPD,FL） were analyzed,and the AO Z-score and PA Z-score of normal fetuses were calculated. One hundred and six singleton fetuses with AS were studied whose gestational age ranged from 15 to 40 weeks. The AO Z-score and PA Z-score of AS fetuses obtained by using above regression equation and PA/AO ratio were subsequently calculated. The AO and PA Z-scores and PA/AO ratio between normal fetuses and AS fetuses were compared. And the detection rate of AS according to AO Z-score,PA/AO ratio and AO percentile range were assessed. Results Compared with normal fetuses, the Z-score of AO and the PA/AO ratio in AS fetuses were statistically different （ P 〈0.01）. While there was no statistical difference of Z-score of PA between two groups （ P 〉0.05）. AO Z-score in 96.2% of AS fetuses were found （ - 3,PA/AO ratio in 95.3% of AS fetuses were found outside 95% CI. The method using AO Z-score had the highest detection rate of AS, the positive predictive value was up to 89.5 %,the negative predictive value was up to 98.6%, the sensitivity, specificity and Youden index were 96.2% ,96%, and 0.9223, respectively. PA/AO ratio had

关 键 词：超声心动描记术 胎儿 主动脉狭窄 生物统计学 Z-评分 

分 类 号：R714.5[医药卫生—妇产科学] R540.45[医药卫生—临床医学]