胎儿静脉导管产前超声参数联合母体血清miR-19b对胎儿先天性心脏病的诊断价值  

Value of Prenatal Ultrasound Parameters of Fetal Ductus Venosus Combined with Maternal Serum MiR-19b in Diagnosis of Fetal Congenital Heart Disease

作　　者：周钰昆 张金辉[1] 张伟[1] 张雪松[1] 梁宏伟[1] 王瑞玲[1] 郑婷华 ZHOU Yu-kun;ZHANG Jin-hui;ZHANG Wei;ZHANG Xue-song;LIANG Hong-wei;WANG Rui-ling;ZHENG Ting-hua(Department of Ultrasound,Maternal and Child Health Hospital of Tangshan City,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市妇幼保健院超声科,河北唐山063000

出　　处：《临床误诊误治》2022年第4期74-78,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划指导项目(20160841)。

摘　　要：目的探讨胎儿静脉导管产前超声参数联合母体血清miR-19b对胎儿先天性心脏病的诊断价值及意义。方法选取2019年1月—2020年12月规律接受产检的2504例孕妇作为研究对象进行前瞻性队列研究,均行产前胎儿超声检查与母体血清miR-19b检测,根据产后随访结果分为病例组(均为先天性心脏病)、对照组(均无先天性心脏病),比较两组胎儿静脉导管心室收缩期峰值流速(S)、心室舒张期峰值流速(D)、峰值流速指数(PVIV)、前负荷指数(PLI)、S/心房收缩期速度(A)及miR-19b,采用多因素Logistic回归分析胎儿先天性心脏病的相关影响因素,采用受试者工作特征(ROC)曲线分析PVIV、PLI、S/A、miR-19b及联合诊断胎儿先天性心脏病的价值。结果病例组PVIV、PLI、S/A及miR-19b高于对照组(P<0.05)。PVIV、PLI、S/A及miR-19b均为胎儿先天性心脏病发生的独立危险因素(P<0.01)。PVIV、PLI、S/A联合miR-19b诊断胎儿先天性心脏病的ROC曲线下面积最大。PVIV、PLI、S/A、miR-19b高水平组胎儿先天性心脏病发生率高于低水平组(P<0.01)。结论应用超声检测胎儿静脉导管PVIV、PLI、S/A联合母体血清miR-19b可用于胎儿先天性心脏病的产前诊断,从而为临床治疗、妊娠决策提供参考。Objective To investigate the value and significance of prenatal ultrasound parameters of fetal ductus venosus combined with maternal serum microRNA-19 b(miR-19 b)in diagnosis of fetal congenital heart disease(CHD).Methods A prospective cohort study of 2504 pregnant women who had received regular obstetric examinations between January 2019 and December 2020 was performed.Prenatal fetal ultrasonography and maternal serum miR-19 b detection were performed for all the pregnant women,and then they were divided into case group(all children with CHD)and control group(all without CHD)according to results of postpartum follow-up.Levels of peak systolic flow velocity(S)of fetal ductus venosus,ventricular diastolic peak flow velocity(D),peak velocity index for veins(PVIV),preload index(PLI),S/atrial systolic velocity(A)and miR-19 b were compared between two groups.Multivariate Logistic regression analysis was used to analyze related influencing factors of fetal CHD,and receiver operating characteristics(ROC)curve was used to analyze values of PVIV,PLI,S/A,miR-19 b and combined detection in diagnosis of fetal CHD.Results Levels of PVIV,PLI,S/A and miR-19 b in case group were significantly higher than those in control group(P<0.05).PVIV,PLI,S/A and miR-19 b were all independent risk factors for occurrence of fetal CHD(P<0.01).The area under the ROC curve of PVIV,PLI and S/A combined with miR-19 b in diagnosis of fetal CHD was the largest.The incidence rate of fetal CHD in the group with high levels of PVIV,PLI,S/A and miR-19 b was significantly higher than that in the low levels group(P<0.05).Conclusion Ultrasound detection of PVIV,PLI and S/A in fetal ductus venosus combined with maternal serum miR-19 b may be used for prenatal diagnosis of fetal CHD,thereby it may provides reference for clinical treatment and pregnancy decision-making.

关 键 词：先天性心脏病 胎儿 胎儿静脉导管 超声检查 产前 微小RNA-19b 产前诊断 

分 类 号：R714.5[医药卫生—妇产科学] R541.1[医药卫生—临床医学]