超声心动图对中晚孕期正常胎儿的心房内径及其Z-评分的定量研究  

Quantitative study of atrial diameter and Z-score of normal fetuses in middle and late trimester by echocardiography

作　　者：张商迪 赵博文[1] 潘美[1] 彭晓慧[1] 陈冉[1] 毛彦恺[1] 陈阳 袁华 Zhang Shangdi;Zhao Bowen;Pan Mei;Peng Xiaohui;Chen Ran;Mao Yankai;Chen Yang;Yuan Hua(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 Diagnostic Ultrasound,Shaoxing Women&Children′s Hospital,Shaoxing 312000,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]浙江省绍兴市妇女儿童医院超声科,绍兴312000

出　　处：《中华超声影像学杂志》2023年第11期959-967,共9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(LGF22H180043);浙江省基础公益研究计划项目(LGF22H180008)

摘　　要：目的:分析中晚孕期正常胎儿的左、右心房内径与胎儿生物学生长参数的关系,初步构建左、右心房内径正常参考值范围及其Z-评分模型。方法:前瞻性选取2022年7-10月浙江大学医学院附属邵逸夫医院392例中晚孕期正常单胎胎儿,获得胎儿生物学生长参数,包括双顶径(BPD)、股骨长(FL)、孕周(GA)等。通过胎儿超声心动图标准心尖或基底四腔心切面,于收缩末期测量左、右心房横径(LAW、RAW)、长径(LAL、RAL),用画迹法于收缩末期测量左、右心房面积(LAA、RAA),舒张末期测量心脏面积(HA),计算右、左心房横径之比(RAW/LAW)、长径之比(RAL/LAL)、面积之比(RAA/LAA),左、右心房长径与横径之比的球形指数(LASI,RASI),左、右心房面积与心脏面积之比(LAA/HA,RAA/HA)。以GA、BPD及FL作为自变量,以LAL、LAW、LAA、RAL、RAW、RAA为因变量建立最佳拟合的回归方程,分析标准差(SD)与自变量GA、BPD及FL之间的相关性,通过以上统计数据,应用回归方程得出左、右心房各径线相应的Z-评分。结果:①LAW、RAW、LAL、RAL、LAA、RAA随GA、BPD和FL的增加而增长,呈显著正相关,其中以RAA、LAA与GA的相关程度最高( r=0.927、0.920,均 P<0.001)。②以GA为例,RAL/LAL、RAW/LAW与GA无明显相关性( r=-0.064、0.077,均 P>0.05),RAA/LAA与GA呈极弱正相关( r=0.106, P=0.037),正常参考值分别为1.002±0.091、1.091±0.093、1.059±0.090,且RAL/LAL接近于1,而RAW/LAW、RAA/LAA始终>1;LAA/HA、RAA/HA与GA均无明显相关性( r=0.003、0.056,均 P>0.05),正常参考值分别为0.155±0.026、0.163±0.026,且RAA/HA>LAA/HA;LASI与GA呈极弱正相关( r=0.112, P=0.027),RASI与GA无明显相关性( r=0.003, P>0.05),正常参考值分别为1.068±0.113、0.980±0.105。③LAL、LAW等的SD与自变量呈简单线性关系,以RAA与GA为例,RAA的直线回归方程:Y=-1.690+0.107 0GA( r=0.927, P<0.001),RAA-SD直线回归方程:Y=-0.107+0.010 4GA( r=0.320, P<0.001)。LAL、LAW、LAA、RAL、RAW�ObjectiveTo analyze the correlation between left and right atrial diameters and fetal biological growth parameters of normal fetuses in middle and late trimester,and to establish normal reference and Z-score model for left and right atria.MethodsThree hundred and ninety-two fetuses in middle and late trimester were prospectively selected from July 2022 to October 2022 in Sir Run Run Shaw Hospital.Non-cardiac biometric parameters included biparietal diameter(BPD),femoral length(FL),and gestational age(GA)based on menstrual age were assessed.Left and right atrial widths(LAW,RAW)and atrial lengths(LAL,RAL)at end-systole,left and right atrial areas(LAA,RAA)at end-systole and the heart area(HA)at end-diastole were measured in standard apical four-chamber or basal four-chamber view.The ratio of RA and LA transverse diameters(RAW/LAW),the ratio of RA and LA length diameters(RAL/LAL),ratio of RA and LA area(RAA/LAA),spherical index of the ratio of RA and LA length to transverse diameter(RASI,LASI),ratio of LA and RA area to heart area(LAA/HA,RAA/HA)were calculated.The best regression equation was established using GA,BPD and FL as independent variables and LAL,LAW,LAA,RAL,RAW,RAA as dependent variable.The correlation between the standard deviation(SD)and the independent variables GA,BPD and FL was analyzed,and then the above statistics were used to calculate the corresponding Z-score for each variable of RA and LA using the regression equation.Results①Significant positive correlations were found between LAW,RAW,LAL,RAL,LAA and RAA with the increase of GA,BPD and FL,and the highest degree of correlation between RAA,LAA and GA was denoted(r=0.927,0.920,all P<0.001).②Taking GA as an example,there was no significant correlation between RAL/LAL,RAW/LAW and GA(r=-0.064,0.077;all P>0.05).RAA/LAA showed a very weak positive correlation with GA(r=0.106,P=0.037),with normal reference values of 1.002±0.091,1.091±0.093,1.059±0.090,respectively.Interestingly RAL/LAL was found close to 1,while RAW/LAW and RAA/LAA were always>1.

关 键 词：超声心动描记术 胎儿 心房内径 四腔心切面 Z-评分 

分 类 号：R540.45[医药卫生—心血管疾病] R714.5[医药卫生—内科学]