基于二维斑点追踪技术制定妊娠28~39周低风险胎儿心脏大小和形态的参考值范围  

Reference ranges of cardiac size and morphology for low-risk fetuses at 28-39 gestational weeks based on two-dimensional speckle tracking technique

作　　者：朱晨 须成杰 刘芮 李嫚 熊钰 项金莲 任芸芸 ZHU Chen;XU Cheng-jie;LIU Rui;LI Man;XIONG Yu;XIANG Jin-lian;REN Yun-yun(Department of Ultrasound,Fudan University,Shanghai 200011,China;Department of Information Technology,Fudan University,Shanghai 200011,China;Department of Obstetrics,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院超声科,上海200011 [2]复旦大学附属妇产科医院信息科,上海200011 [3]复旦大学附属妇产科医院产科,上海200011

出　　处：《复旦学报（医学版）》2024年第1期41-49,共9页Fudan University Journal of Medical Sciences

基　　金：上海市卫健委卫生行业临床研究专项课题(202140217);中国超声医师“科技新星”项目(KJXX2020004)。

摘　　要：目的采用二维斑点追踪技术制定妊娠28~39周的低风险胎儿心脏大小和形态的参考值范围。方法前瞻性收集复旦大学附属妇产科医院行超声心动图检查的低风险单胎妊娠453例,应用二维斑点追踪技术评估胎儿四腔心和心室的大小(长径、宽径和面积)及形态(球形指数,即长径与宽径的比值)。使用同类相关系数评估组间和组内测量的重复一致性。对心脏测量参数进行统计分析,建立低风险胎儿心脏大小和形态的参考值范围。结果胎儿心脏参数测量的重复一致性检验的组间和组内相关系数为0.691~0.980。胎儿四腔心和心室大小随孕周的增加而增加(均P<0.001),左室舒张末期长径大于右室,舒张末期宽径小于右室,差异均有统计学意义(均P<0.001),而两心室的舒张末期面积对比差异无统计学意义(P=0.050)。四腔心的球形指数与孕周不存在相关性(P=0.811)。左室的基底段和中间段的球形指数大于右室,心尖段的球形指数小于右室,差异均有统计学意义(均P<0.01)。结论采用二维斑点追踪技术评估胎儿心脏参数具有较好的可重复性。本研究制定的低风险胎儿心脏大小和形态参考值范围,将为产前评价心脏重塑提供帮助。Objective To construct reference ranges of cardiac size and morphologic parameters in low-risk fetuses at 28-39 gestational weeks using two-dimensional speckle tracking technique.Methods A prospective collection of 453 low-risk singleton pregnancies with echocardiography at Obstetrics and Gynecology Hospital,Fudan University was used to assess the size(length,width,and area)and morphology(sphericity index,i.e.,the ratio of length to width)of the fetal four-chamber view and two ventricles using two-dimensional speckle tracking technique.Repeated inter-and intra-observer agreement of measurements was assessed using the intraclass correlation coefficients(ICCs).Statistical analysis of cardiac measurement parameters was performed to establish reference ranges of values for cardiac size and morphology in low-risk fetuses.Results The inter-and intra-group ICCs for reproducibility tests of fetal cardiac parameters measurements were 0.691 to 0.980.Fetal four-chamber view and ventricular size increased with gestational week(all P<0.001),the end-diastolic length of the left ventricle was larger than that of the right ventricle,and the end-diastolic diameter was smaller than that of the right ventricle(both P<0.001),while there was no significant difference in the end-diastolic area of the two ventricles(P=0.050).The spherical index of four-chamber view did not correlate with gestational week(P=0.811).The sphericity index of the basal and intermediate segments of the left ventricle was greater than that of the right ventricle,and the sphericity index of the apical segment was less than that of the right ventricle,the differences were statistically significant(all P<0.01).Conclusion The two-dimensional speckle tracking technique for measuring fetal cardiac parameters has good reproducibility.The reference ranges for cardiac size and morphology in low-risk fetuses developed in this study will be useful for prenatal evaluation of cardiac remodeling.

关 键 词：超声心动图 斑点追踪 fetalHQ 心脏大小 球形指数(SI) 胎儿 

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]