胎儿心脏定量分析技术对右心室流出道梗阻性疾病胎儿心脏大小、形态和功能的研究  

Investigation of fetal cardiac size,morphology and function in fetuses with right ventricular outflow obstruction using fetal heart quantification

作　　者：李金晶 赵博文[1] 潘美[1] 彭晓慧[1] 陈冉[1] 陈阳 Li Jinjing;Zhao Bowen;Pan Mei;Peng Xiaohui;Chen Ran;Chen Yang(Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University College of Medicine,Technical Guidance Center for Fetal Echocardiography of Zhejiang Province&Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,Hangzhou 310016,China;Department of Ultrasound,Huzhou First People′s Hospital,Huzhou 313000,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,浙江省胎儿心脏超声诊断技术指导中心,浙江大学邵逸夫临床医学研究所,杭州310016 [2]湖州市第一人民医院超声科,湖州313000

出　　处：《中华超声影像学杂志》2022年第10期859-864,共6页Chinese Journal of Ultrasonography

基　　金：浙江大学科学技术研究院一般横向项目(校合-2021-KYY-518053-0055);浙江省基础公益研究计划项目(LGF20H180013)。

摘　　要：目的探讨胎儿心脏定量(fetal HQ)分析技术在右室流出道梗阻性疾病(RVOTO)胎儿心脏大小、形态及功能评估中的应用价值。方法选取2020年4月至2021年2月在浙江大学医学院附属邵逸夫医院经胎儿超声心动图诊断为RVOTO的胎儿55例,根据其是否合并其他心血管畸形,分为单纯性肺动脉狭窄(PS)组和动脉圆锥干畸形(CTD)组。在标准四腔心切面,利用fetal HQ分析技术获得舒张末期基底-心尖长度(4CV-Length)、横向宽度(4CV-Width),计算心脏整体球形指数(4CV-GSI)。将左、右心室由基底至心尖分为24节段,利用fetal HQ追踪获得心室内膜曲线,计算得出24节段横向宽度(ED)、球形指数(SI)、短轴缩短率(FS)及其Z-评分。从心脏大小、形态及功能方面对RVOTO胎儿左、右心室进行对比分析。结果RVOTO胎儿心脏4CV-Length在正常范围,4CV-Width不同程度增大,GSI下降,心脏整体呈球形改变。PS组左室ED较右室增大,在S5~24节段差异有统计学意义(P<0.05),左室较右室更趋球形;CTD组左、右心室ED比较差异无统计学意义(P>0.05),右室较左室更趋球形;RVOTO胎儿24节段FS均不同程度下降,PS组左、右心室在S5~19节段比较差异有统计学意义(P<0.05),CTD组左、右心室在S1~11节段比较差异有统计学意义(P<0.05),且右室较左室下降更明显。结论fetal HQ分析技术能够对RVOTO胎儿心脏大小、形态及功能提供更多有价值的信息。Objective To investigate the application value of fetal heart quantification(fetal HQ)in the evaluation of fetal heart size,morphology and function in fetuses with right ventricular outflow obstruction(RVOTO).Methods Fifty-five fetuses diagnosed as RVOTO by fetal echocardiography in Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University from April 2020 to February 2021 were selected.They were divided into simple pulmonary artery stenosis(PS)group and conus arteriosus malformation(CTD)group according to whether they were combined with other cardiovascular malformations.On the standard four chamber view,the end diastolic basal apical length(4CV length)and transverse width(4CV width)were obtained by fetal HQ analysis technique,and the cardiac global spherical index(4cv-gsi)was calculated.The left and right ventricles(LV and RV)were divided into 24 segments from the base to the apex.The endocardial curve was obtained by total HQ tracking.The 24 segment transverse width(ED),spherical index(SI),short axis shortening(FS)and its Z-score were calculated.The LV and RV of RVOTO fetuses were compared and analyzed from the aspects of heart size,morphology and function.Results The 4CV length of RVOTO fetal heart was in the normal range,4CV width increased in varying degrees,GSI decreased,and the whole heart showed spherical changes.In PS group,LV-ED was larger than that of RV and the difference was statistically significant in 5-24 segments(P<0.05).LV was more spherical than RV.There was no significant difference in ED between LV and RV in CTD group(P>0.05),and RV was more spherical than LV.Twenty-four segment FS decreased in different degrees in RVOTO fetal heart,and the decrease of RV was more obvious than that of LV.There was significant difference between the LV and RV in PS group from S5 to 19(P<0.05),and there was significant difference between the left and right ventricles in CTD group from S1 to 11(P<0.05).Conclusions Fetal HQ can provide new insights of cardiac size,morphology and function in f

关 键 词：超声心动描记术 右室流出道梗阻 胎儿心脏定量分析技术 Z-评分 

分 类 号：R714.5[医药卫生—妇产科学]