二维超声指标对中孕期胎儿主动脉缩窄的诊断价值分析  

The analysis on the diagnostic value of two-dimensional ultrasonic indicators of fetal aorta coarctation in the second trimester of pregnancy

作　　者：王连双[1] 刘晓伟[1] 薛超[1] 满婷婷[1] 张军[2] 陈东[3] 何怡华[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管病症研究所超声科,100029 [2]首都医科大学附属北京安贞医院妇产科,100029 [3]首都医科大学附属北京安贞医院病例科,100029

出　　处：《心肺血管病杂志》2016年第5期386-391,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科委课题(215110000391542);胎儿心脏畸型网络平台建设支撑计划(2014BA108B07)

摘　　要：目的：对比分析二维超声指标在中孕期胎儿主动脉缩窄方面的应用价值,为产前诊断和围产期管理提供依据。方法：回顾分析2013年1月至2015年12月,于北京安贞医院胎儿心脏病母胎医学会诊中心,经产前超声心动图检查提示可疑主动脉缩窄的43例胎儿影像数据资料。43例主动脉缩窄胎儿临床资料完整,孕妇年龄21-40岁,平均（30.0±4.1）岁,孕周20-28周,平均（23.5±4.1）周。以出生后超声心动图证实为金指标,43例胎儿中15例经出生后或尸检证实为主动脉缩窄,确定为A组;28例经出生后或尸检证实为正常胎儿,确定为B组。以主动脉峡部Z-分数（Z-Ao I）、主肺动脉内径/升主动脉内径（MPAd/AAOd）、主动脉峡部内径/动脉导管内径（AOId/DAd）、三尖瓣环横径/二尖瓣环横径（TVd/MVd）为指标,分析其提示中孕期胎儿主动脉缩窄的灵敏度、特异度以及与金标准的一致性（Kappa值）;计算胎儿主动脉瓣环径（AOd）、升主动脉内径（AAOd）、主动脉峡部内径（AOId）作为超声指标提示中孕期胎儿主动脉缩窄的cot-off值以及该cut-off值的灵敏度、特异度和Kappa值。结果：1以MPAd/AAOd≥1.6,AOId/DAd〈0.74,TVd/MVd〉1.5,Z-Ao I〈-2为界值,提示主动脉缩窄的灵敏度分别为76.0%、82.9%、20.0%、80.1%,特异度分别为80.3%、80.0%、80.0%、91.4%,Kappa值分别为0.693、0.740、0.246、0.789;2制作ROC曲线,显示AOd〈3.45mm、AAOd〈3.55mm、AOId〈1.95mm为cut-off值,提示主动脉缩窄的灵敏度分别为92.9%、65.0%、86.7%;特异度分别为98.0%,73.0%,86.4%;经过一致性检验,三项指标的Kappa值分别为0.901,0.599,0.740。结论：1本研究的各项二维超声诊断指标中,主动脉瓣环内径在中孕期提示胎儿主动脉缩窄有非常重要的临床价值,与出生后超声心动图检查或尸检金标准的一致性最高;2主肺动脉内径/升主动脉内径、主动脉峡部内径/动脉导管内径、主动脉峡部Z-分数�Objective：Comparatively analysis application value of two dimensional uhrasonic indicators of fetal aorta coarctation in the second trimester of pregnancy, and provide the basis for prenatal diagnosis and perinatal management. Methods ： t/etrospective analysis imaging data of 43 cases of fetus suspicious aorta eoarction in the second trimester of pregnancy diagnosised by fetal echocardiography in Beijing Anzhen Hospital Consultation Center of Maternal Fetal Medicine in Heart Disease from January 2013 to December 2015.43 cases of fetal aortic coarctation have The complete clinical data, pregnant women were 21 to 40 years old, the average （30.0 ± 4. 1 ） years old, gestational age were 20 to 28 weeks, the average （23.5 ± 4. 1 ） weeks. Confirmed by echocardiography after birth or autopsy as golden standard, 15 cases of aorta coarctation confirmed after birth, identified as A group; 28 cases of normal fetus confirmed after birth or autopsy, identified as group B. Aorta isthmus Z-score（ Z-AoI）, the main pulmonary artery diameter/ascending aorta diameter（ MPAd/AAOd）, aortic isthmus diameter/arterial ductus diameter（ AOId/ DAd）, tricuspid valve ring diameter/mitral ring diameter （TVd/MVd） as indicators, to analyze their sensitivity, specific degrees and the consistency with gold standard （ Kappa value） ; Calculate the cut - off value of fetal aortic valve ring diameter（AOd） , aortic isthmus diameter （AOId）and ascending aorta diameter（AAOd）as ultrasonic indicators and the sensitivity, specific degree and Kappa value of the cut - off value. Results： ①MPAd/AAOd ≥ 1.6, AOId/DAd 〈 0. 74, TVd/MVd 〉 1.5, Z - AoI 〈 - 2 as the boundary value, suggesting the sensitivity of aorta coactation in the second trimester of preg- nancy were 76. 00%, 82.9%, 20. 0%, 80. 1% respectively, specific degree were 80. 3%, 80.0%, 80. 0%, 91.4% respectively, Kappa value were 0. 693, 0. 740, 0. 246, 0. 789 respectively; ②the ROC curve showing the AOd 〈3.45 mm, AAOd 〈3.55 ram, AOId 〈 1

关 键 词：胎儿超声心动图 主动脉缩窄 二维超声心动图 指标 

分 类 号：R54[医药卫生—心血管疾病]