中孕早期胎儿心脏超声检查在先天性心脏病筛查中的价值分析  

Analysis of the value of fetal echocardiography in congenital heart disease screening at the early second trimester

作　　者：陈昌秀[1] 赵颉[1] 张雪梅[1] 冯露[1] 王渝娜 CHEN Chang-xiu;ZHAO Jie;ZHANG Xue-mei;FENG Lu;WANG Yu-na(Department of Ultrasound,Xichang People's Hospital,Xichang 615000,China)

机构地区：[1]四川省西昌市人民医院超声医学科,四川西昌615000

出　　处：《实用医院临床杂志》2023年第1期36-40,共5页Practical Journal of Clinical Medicine

基　　金：四川省科技厅重点研发项目(编号:2020YFS0538)。

摘　　要：目的 探讨中孕早期应用胎儿心脏超声检查在胎儿先天性心脏病筛查中的价值。方法 对有先心病高危因素及其他早期筛查胎儿心脏需求的82名孕妇,92例胎儿,在孕14~16周经孕妇腹壁对胎儿心脏进行超声检查;同时期具有同类先心病高危因素或筛查需求的1846名孕妇、1856例胎儿中孕中期心脏超声筛查结果为对照组。记录两组切面获得情况和检查结果;以引产后及出生后结果为金标准,计算该时期超声检查的灵敏度、特异度、准确度、阳性预测值和阴性预测值。结果 研究组92例胎儿中孕早期检查全部完成,各切面平均获得率为99%;心脏结构阴性81例,中孕中期复查检出永存左上腔静脉1例;检出先天性心脏病11例,1例室间隔缺损在中孕中期复查时未见异常,中孕早期先心病超声筛查的灵敏度90.9%,特异度98.7%,准确度97.7%,阳性预测值90.9%,阴性预测值98.7%;另检出心内染色体异常软指标三尖瓣反流3例和心室灶状强回声17例,经羊水穿刺明确染色体异常1例。对照组检出胎儿先心病47例,灵敏度97.9%,特异度99.9%,准确度99.9%,阳性预测值97.9%,阴性预测值99.9%,两组比较差异无统计学意义(P>0.05)。结论 在中孕早期进行胎儿心脏超声检查能够检出严重复杂的心脏畸形和部分简单畸形,发现心内染色体异常的软指标,对出生缺陷早期防治具有重要价值。Objective To investigate the value of fetal echocardiography in congenital heart disease screening at the early second trimester.Methods For 82 pregnant women and 92 fetuses with high risk factors for congenital heart disease and other needs for early screening of fetal heart, ultrasound examination of fetal heart was performed through the abdominal wall of pregnant women at 14 to 16 weeks of gestation.During the same period, 1,846 pregnant women and 1,856 fetuses with similar congenital heart disease high risk factors or screening needs were selected as a control group.The slice acquisitions and examination results were recorded. The results of the examination were compared and analyzed with the results of diagnosisafter induction of labour and after birth. Sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of ultrasound in screening for congenital heart disease during this period were calculated.Results All 92 fetusesexaminationsat the early second trimester of the research group were completed,. The average acquisition rate of each section was 99%. There were 81 cases with negative cardiac structures and 1 case with permanent left superior vena cava at the mid-second trimester. There were 11 cases of congenital heart disease and 1 case of ventricular septal defect whichwas not abnormal at mid-second trimester review. The sensitivity of ultrasound screening for congenital heart disease in the early second trimester was 90.9%, specificity was 98.7%, accuracy was 97.7%, PPV was 90.9% and NPV was 98.7%. In addition, in fetuses without abnormal cardiac structure, 19 cases of chromosomal abnormal soft indicators were detected in the heart, including 3 cases of tricuspid regurgitation, 17 cases of ventricular focal hyperecho, and 1 case of chromosomal abnormality confirmed by amniocentesis. In the control group, there were 47 cases of fetal congenital heart disease. The sensitivity was 97.9%, specificity was 99.9%,accuracy was99.9%, PPV was 97.9%, and NPV was 99.9%.

关 键 词：中孕早期 胎儿心脏 超声 切面 先天性心脏病 

分 类 号：R541.1[医药卫生—心血管疾病] R714.5[医药卫生—内科学] R445.1[医药卫生—临床医学]