超声参数联合诊断胎儿先天性心脏病效果  

Efficacy of the combination of multiple prenatal ultrasound parameters for diagnosing the fetal congenital heart disease

作　　者：边焕杰 孙瑞先 陈阳 BIAN Huanjie;SUN Ruixian;CHEN Yang(Zhuji Maternal and Child Health Care Hospital,Zhuji,Zhejiang Province,311800)

机构地区：[1]浙江省诸暨市妇幼保健院,311800

出　　处：《中国计划生育学杂志》2023年第12期2991-2994,2999,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨孕期超声参数联合检测诊断胎儿先天性心脏病(CHD)价值。方法:收集2020年6月-2022年12月于本院常规产前检查的140例孕妇临床资料,孕20~28周均行产前胎儿超声检查,记录胎儿心脏功能参数及静脉导管血流指标,对超声检查怀疑孕有CHD胎儿的孕妇追踪随访。以引产后尸检病理或产后婴幼儿超声检查(随访结果)为金标准,统计孕期超声检查对胎儿CHD的诊断准确率,比较正常胎儿与CHD胎儿心脏功能、静脉导管血流指标差异,分析孕期超声参数联合检测诊断胎儿CHD效能。结果:入组140例胎儿中正常组94例(67.1%),随访至胎儿出生,各项评分均正常;CHD组46例(32.9%)。46例胎儿CHD室间隔缺损占12.1%、法洛四联症占5.7%、房室间隔缺损占5.0%、主动脉弓缩窄占3.6%、肺动脉狭窄占2.9%,大动脉转位占2.1%和肺动脉闭锁占1.4%,孕期超声诊断胎儿CHD准确率为83.6%(117/140)。与正常组相比,CHD组胎儿主动脉/肺动脉内径比值、峰值流速指数(PVIV)、收缩期峰值流速/心房收缩期速度比值(S/A)更高,舒张末期容积(EDV)、射血分数(EF)更低(均P<0.05)。受试者工作特征曲线分析,主动脉/肺动脉内径比值、EDV、LVEF、PIVI及S/A联合诊断产前胎儿CHD的ROC曲线下面积(AUC)(0.888)高于各项指标单独诊断(均P<0.05)。结论:CHD胎儿与正常胎儿孕期超声参数存在差异,参数联合检测能提高胎儿CHD的早期诊断准确率。Objective:To investigate the value of the combination of multiple prenatal ultrasound parameters for diagnosing the fetal congenital heart disease(CHD).Methods:The clinical data of 140pregnant women who received routine prenatal examinations from June 2020to December 2022were collected.These women had received prenatal fetal ultrasound examination during 20-28gestational weeks,and the fetal cardiac function parameters and venous blood flow indicators of the women were recorded.The pregnant women with the suspected fetal CHD after ultrasound examination were followed up.The results of the pathological autopsy of the fetuses after induced abortion or the postpartum ultrasound examination of the neonates during followed up were taken as the golden standards,the diagnostic accuracy of the prenatal ultrasound examination for the fetal CHD was calculated.The cardiac function and the differences of venous blood flow indicators were compared between the normal fetuses and the fetuses with CHD.The diagnostic efficacy of the combined of multiple prenatal ultrasound parameters for the fetal CHD was analyzed.Results:Of 140fetuses enrolled in this study,there were 94(67.1%)normal fetuses with all normal scores after followed up to born in group A,and 46(32.9%)fetuses with CHD in group B.In group B,the proportions of fetuses with ventricular septal defect,tetralogy of Fallot,atrioventricular septal defect,aortic arch coarctation,pulmonary stenosis,transposition of great arteries,and pulmonary artery atresia of the fetuses were 12.1%,5.7%,5.0%,3.6%,2.9%,2.1%,and 1.4%,respectively.The accuracy rate of the prenatal ultrasound for diagnosing the fetal CHD was 83.6%(117/140).The values of aortic/pulmonary artery diameter ratio,peak velocity index(PVIV),peak systolic velocity/atrial systolic velocity ratio(S/A)of the fetuses in group B were significantly higher than those of the fetuses in group A,while the values of the end diastolic volume(EDV)and ejection fraction(EF)of the fetuses in group B were significantly lower than those o

关 键 词：胎儿先天性心脏病 孕中期 超声多普勒 超声参数 诊断价值 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]