孕早期颈项透明层厚度和静脉导管血流参数及心轴对胎儿先天性心脏病的预测价值  

Value of combined detection of nuchal translucency thickness,ductus venosus blood flow parameters and cardiac axis in the first trimester to the prediction of fetal congenital heart disease

作　　者：赵丽娟[1] 郭煜[1] 王璐[1] 宁艳婷 张鹏杰 孔祥东[2] ZHAO Li-juan;GUO Yu;WANG Lu;NING Yan-ting;ZHANG Peng-jie;KONG Xiang-dong(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China;Genetics and Prenatal Diagnosis Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学第一附属医院超声科,河南郑州450003: [2]郑州大学第一附属医院遗传与产前诊断中心,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2022年第6期634-637,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家重点研发计划(2018YFC1002206-2)。

摘　　要：目的观察孕早期(11~13^(+6)周)先天性心脏病(congenital heart disease,CHD)胎儿超声颈项透明层(nuchal translucency,NT)厚度、静脉导管(ductus venosus,DV)血流参数和心轴变化,探讨其对胎儿发生CHD的预测价值。方法孕早期孕妇500例,均应用彩色多普勒超声检测胎儿NT厚度、DV血流参数(包括心室收缩期峰值流速、心室舒张期峰值流速、心房收缩期峰值流速)和心轴。根据孕18~22周时胎儿超声心动图检查结果分为CHD组16例和对照组484例,比较2组年龄、孕周、体质量指数、初产比例及胎儿NT厚度、DV血流参数、心轴等临床资料。绘制ROC曲线,评估孕早期胎儿NT厚度联合DV血流参数、心轴对胎儿发生CHD的预测效能。结果2组年龄、孕周、体质量指数、初产妇比率比较差异均无统计学意义(P>0.05)。CHD组胎儿三尖瓣下移畸形1例,室间隔缺损1例,完全性大动脉移位3例,左心发育不良2例,法洛四联症2例,完全性心内膜垫缺损3例,三尖瓣闭锁1例,右心室发育不良1例,单一动脉干2例。CHD组胎儿NT厚度[(2.24±0.54)mm]、心室收缩期峰值流速[(72.68±16.73)cm/s]、心室舒张期峰值流速[(67.27±11.71)cm/s]、心房收缩期峰值流速[(45.29±9.24)cm/s]、心轴[(52.69±15.88)°]均大于对照组胎儿[(1.74±0.33)mm、(57.75±11.21)cm/s、(54.71±10.07)cm/s、(35.52±8.61)cm/s、(33.97±7.67)°](P<0.05)。孕早期胎儿NT厚度、心室收缩期峰值流速、心室舒张期峰值流速、心房收缩期峰值流速及心轴的最佳截断值分别为2.54 mm、68.69 cm/s、63.56 cm/s、45.60 cm/s、45.94°时,预测胎儿发生CHD的AUC分别为0.763(95%CI:0.617~0.910,P<0.001)、0.757(95%CI:0.613~0.901,P<0.001)、0.803(95%CI:0.686~0.921,P<0.001)、0.771(95%CI:0.652~0.890,P<0.001)、0.801(95%CI:0.691~0.910,P<0.001),灵敏度分别为62.5%、62.5%、75.0%、56.3%、56.3%,特异度分别为90.5%、84.1%、82.0%、90.7%、84.3%。五者联合检测预测胎儿发生CHD的AUC(0.853)大于单独检测Objective To observe the nuchal translucency(NT)thickness,blood flow parameters of ductus venosus(DV)and cardiac axis of fetus in the first trimester(11 to 13^(+6) weeks),and to investigate their values to the prediction of fetal congenital heart disease(CHD).Methods Totally 500 pregnant women were measured the fetal NT thickness,DV blood flow parameters(ventricular peak systolic velocity,ventricular peak diastolic velocity and atrial peak systolic velocity)and cardiac axis in the first trimester by color Doppler ultrasound,and were divided into CHD group(n=16)and control group(n=484)according to the results of echocardiography at 18 to 22 weeks gestation.The clinical data as age,gestational age,body mass index,percentage of primipara,NT thickness,DV blood flow parameters and cardiac axis were compared between two groups.ROC curve was drawn to evaluate the efficiency of fetal NT thickness combined with DV blood flow parameters and cardiac axis on predicting fetal CHD in the first trimester.Results There were no differences in the age,gestational age,body mass index,and percentage of primipara between two groups(P>0.05).In CHD group,there were 1case of fetal tricuspid valve descending malformation,1case of ventricular septal defect,3cases of complete transposition of the great arteries,2cases of left heart dysplasia,2cases of tetralogy of Fallot,3cases of complete endocardial cushion defect,1case of tricuspid valve atresia,1case of right ventricular dysplasia and 2cases of single arterial trunk.The fetal NT thickness[(2.24±0.54)mm],ventricular peak systolic velocity[(72.68±16.73)cm/s],ventricular peak diastolic velocity[(67.27±11.71)cm/s],atrial peak systolic velocity[(45.29±9.24)cm/s]and cardiac axis[(52.69±15.88)°]in CHD group were greater than those in control group[(1.74±0.33)mm,(57.75±11.21)cm/s,(54.71±10.07)cm/s,(35.52±8.61)cm/s,(33.97±7.67)°](P<0.05).When the optimal cut-offvalues of the fetal NT thickness,ventricular peak systolic velocity,ventricular peak diastolic velocity,atrial peak systoli

关 键 词：先天性心脏病 胎儿 孕早期 超声 颈项透明层厚度 静脉导管 心轴 

分 类 号：R714.5[医药卫生—妇产科学]