正常胎儿心脏大小Z评分模型的超声心动图研究  

A study on normal fetal heart size Z-score model derived from fetal echocardiography

作　　者：黎新艳[1] 周启昌[1] 丘晓霞 田晓先[2] 黄欢[2] 李雪芹[2] 

机构地区：[1]中南大学湘雅二医院超声科,长沙410011 [2]广西壮族自治区妇幼保健院超声科

出　　处：《中华超声影像学杂志》2015年第10期840-844,共5页Chinese Journal of Ultrasonography

基　　金：基金项目：国家自然科学基金（81271593）;广西医疗卫生重点科研课题（重2010063）;广西医药卫生科学研究基金（桂卫科Z2011087）

摘　　要：目的建立正常胎儿心脏大小超声参数的z评分模型。方法对孕14～40周的胎儿进行超声心动图检查，在标准四腔心观测量心脏外形参数心脏横径（HD）、长径（HL）、周长（HC）和面积（HA）作为因变量，以胎体大小参数孕周（GA）、双顶径（BPD）和股骨长径（FL）为自变量，统计分析心脏参数均数和标准差的最佳拟合方程。再应用已建立的z评分模型对一组胎儿心脏疾病进行评估。结果胎儿心脏外形大小与胎体大小参数明显相关。心脏参数的均数相对胎体大小参数的最佳拟合方程为线性或2次方程或3次方程；标准差的最佳拟合方程则为线性或2次方程。与胎体大小相关程度最高的心脏参数为HD（r=0．984~0．986），其次为HL（r=0．981～0．984）、HC（r=0．981～0．982）和HA（r=0．978～0．979）。病例组中4例Ebstein’s畸形和16例重型α-地中海贫血胎儿心脏z评分均不同程度增高。结论胎儿心脏大小z评分的计算简单易行，具有潜在的临床应用价值，尤其在重型α-地中海贫血中可以作为一个新的预测指标。Objective To construct Z score models for normal fetal heart size measurements derived from fetal echocardiography. Methods Fetal echocardiography were performed in 910 normal singleton fetuses from 14th to 40th gestational weeks. Fetal transverse heart diameter （HD）, heart length （HL）, heart circumference （HC） and heart area （HA） were derived from a standard four chamber view during end diastole. Using fetal somatic sizes as independent variables and heart sizes as dependent variables, the regression analyses of the mean （M） and the standard deviation （SD） for each parameter were calculated separately. A group of fetal heart diseases were assessed using these models. Results Strong correlations were found between fetal heart sizes and somatic sizes. Linear-cubic regression equations were each fitted to the models of the means of the heart sizes, whereas linear-quadratic equations were fitted to the models of the SDs. HD （ r = 0.984 - 0.986） was a dependent variable that provided the highest correlation coefficient with all of the fetal sizes,followed by HL （ r = 0.981 - 0.984） ,HC （ r = 0.981 - 0.982） and HA （ r = 0.978- 0.979）. All fetuses with Ebstein＇ s anomaly and most with homozygous α-thalassemia-1 demonstrated Z-scores reflective of increased heart sizes. Conclusions The fetal heart sizes Z-scores models had been constructed. The calculation of Z-scores for heart sizes as a function of fetal somatic size is feasible and simple. They might be useful for quantitative assessment of some cardiac diseases and used as new predictive indicators for homozygous α-thalassemia-I particularly.

关 键 词：超声检查 产前 心脏大小 Z评分 

分 类 号：R540.45[医药卫生—心血管疾病] R714.5[医药卫生—内科学]