胎儿超声心动图标准切面在胎儿单纯室间隔缺损孕期诊断中的作用  

The role of fetal echocardiography standard section in the diagnosis of fetal simple ventricular septal defect during pregnancy

作　　者：庞海苏 朱晓丹[1] 戚夏近 周林玉 PANG Haisu;ZHU Xiaodan;QI Xiajin;ZHOU Linyu(The First Afiliated Hospital of Zhejiang University School of Medicine,Hangzhou,Zhejiang 310003,China)

机构地区：[1]浙江大学医学院附属第一医院,浙江杭州310003

出　　处：《中国优生与遗传杂志》2024年第4期760-768,共9页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨胎儿超声心动图标准切面在胎儿单纯室间隔缺损(i-VSD)孕期诊断中的作用。方法选择2021年11月至2023年3月于浙江大学医学院附属第一医院进行孕期检查的孕妇122例,根据产前检查任何时间的超声心动图诊断和产后随访一年内诊断结果分为i-VSD组(n=50)和正常对照组(n=72),比较两组患者的一般资料、血流动力学参数及超声标准切面相关参数。采用受试者操作特征(ROC)曲线评估胎儿超声心动图标准切面参数联合对孕期胎儿i-VSD中的诊断价值。Logistic回归分析胎儿超声心动图标准切面参数与胎儿i-VSD的关系。采用非条件Logistic回归模型分析主动脉肺动脉峰值流速之比(AO/PA)和室间隔缺损大小(V SD)对孕期胎儿i-VSD的相乘交互作用。多因素Logistic分析孕期胎儿发生i-VSD的独立危险因素。建立结构方程预测模型并进行验证。结果i-VSD组糖尿病、合并结缔病、不良妊娠史、家族病史、孕期接触致畸物质患者比例以及胎儿早期NT值相较于正常对照组患者更高;与正常对照组患者相比,i-VSD组患者脐动脉搏动指数(UA-PI)、脐动脉阻力指数(UA-RI)水平更高,而大脑中动脉搏动指数(MCA-PI)、脑/脐血管搏动指数比值(MCA/UA-PI)、脑/脐血管阻力指数比值(MCA/UA-RI)水平更低(P<0.05);i-VSD组与正常对照组患者AO/PA及VSD等指标间的差异具有统计学意义(P<0.05);胎儿超声心动图标准切面参数对孕期胎儿i-VSD的诊断效能良好。其中AO/PA及VSD两个参数联合诊断i-VSD,诊断效能更高;校正混杂因素后,AO/PA及VSD与孕期胎儿i-VSD呈负相关;交互作用分析结果显示,AO/PA和VSD存在相乘及相加交互作用;多因素Logistic回归分析显示糖尿病、合并结缔病、不良妊娠史、家族病史、孕期接触致畸物质、胎儿早期NT值、UA-PI、UA-RI升高,MCA-PI、MCA/UA-PI、MCA/UA-RI、AO/PA、VSD降低均为孕期胎儿i-VSD的危险因素(P<0.05);结构方程模型�Objective To discuss the role of fetal echocardiography standard section in the diagnosis of fetal simple ventricular septal defect(i-VSD)during pregnancy.Methods A total of 122 pregnant women who underwent prenatal examination in the First Affiliated Hospital of Zhejiang University School of Medicine from November 2021 to March 2023 were selected and divided into i-VSD group(n=50)and normal control group(n=72)according to echocardiography diagnosis at any time during prenatal examination and one year postpartum follow-up.The general data,hemodynamic parameters and parameters of ultrasound standard section were compared between the two groups.Receiver operating characteristic(ROC)were used to evaluate the diagnostic value of fetal echocardiography standard section parameters combined with i-VSD in pregnant fetuses.Logistic regression was used to analyze the relationship between fetal echocardiogram standard section parameters and fetal i-VSD.An unconditional Logistic regression model was used to analyze the multiplicative interactions of the ratio of aortopulmonary peak velocity(AO/PA)and ventricular septal defect size(V SD)on fetal i-VSD during pregnancy.Multivariate Logistic analysis of the independent risk factors of fetal i-VSD during pregnancy.The structural equation prediction model was established and verified.Results The proportion of patients with diabetes mellitus,associated disease,adverse pregnancy history,family history,prenatal exposure to teratogenic substances and early fetal NT value in i-VSD group were higher than those in normal control group.The levels of umbilical artery pulse index(UA-PI)and umbilical artery resistance index(UA-RI)in i-VSD group were higher than those in normal control group.The middle cerebral artery pulse index(MCA-PI),brain/cord blood tube pulse index ratio(MCA/UA-PI),brain/cord blood tube resistance index ratio(MCA/UA-RI)were lower(P<0.05).There were significant differences in AO/PA and V SD between i-VSD group and normal control group(P<0.05).The standard section parame

关 键 词：胎儿 超声心动图 标准切面 单纯室间隔缺损 孕期 

分 类 号：R714.5[医药卫生—妇产科学]