孕早期静脉导管血流频谱参数颈项透明层及心轴对胎儿先天性心脏畸形的预测价值  

Predictive value of early pregnancy UVC flow spectrum parameters,NT and cardiac axis for fetal congenital heart malformations

作　　者：邢娟 米真真 Xing Juan;Mi Zhenzhen(Department of Ultrasound Diagnosis,Pingdingshan Maternal and Child Health Care Hospital,Pingdingshan467000,China)

机构地区：[1]平顶山市妇幼保健院超声诊断科,平顶山467000

出　　处：《实用医技杂志》2024年第5期343-346,共4页Journal of Practical Medical Techniques

摘　　要：目的探讨孕早期脐静脉导管(UVC)血流频谱参数、颈项透明层(NT)及心轴对胎儿先天性心脏畸形(CHD)的预测价值。方法将2021年5月至2023年5月我院收治的106例诊断为CHD胎儿的孕妇为研究组、同期胎儿健康的80名孕妇作为对照组,均行UVC彩色多普勒超声检查,比较2组基线资料、UVC血流频谱参数[心室收缩期峰值速度(S)、心室舒张期峰值速度(D)、心房收缩期峰值速度(a)、A波最大速度(Tamax)、搏动指数(PI)]、NT厚度、心轴角度。Logistic多因素回归分析法明确影响胎儿CHD的危险因素,据此建立预测模型并绘制受试者工作特征曲线(ROC)评估其效能。结果2组年龄、UVC检查时孕周、体质量指数(BMI)等基线资料差异均无统计学意义(P>0.05)。研究组孕早期UVC血流频谱参数S、D、a、Tamax均低于对照组,PI、NT厚度、心轴角度均大于对照组,组间差异有统计学意义(P<0.05)。Logistic多因素回归分析结果显示:S[P<0.001,OR(95%CI)=1.852(1.584,2.680)]、D[P<0.001,OR(95%CI)=1.887(1.644,2.664)]、a[P<0.001,OR(95%CI)=1.907(1.609,2.782)]、Tamax[P<0.001,OR(95%CI)=2.002(1.827,2.794)]、PI[P<0.001,OR(95%CI)=1.992(1.658,2.674)]、NT厚度[P<0.001,OR(95%CI)=1.892(1.624,2.691)]、心轴角度[P<0.001,OR(95%CI)=1.935(1.650,2.719)]是影响胎儿CHD的独立危险因素。基于上述影响胎儿CHD的孕早期UVC血流频谱参数构建logistic回归预测模型:logistic(P)=-40.125+0.629(S)+0.612(D)+0.644(a)+0.659(Tamax)+0.642(PI)+0.628(NT厚度)+0.650(心轴角度),该模型预测胎儿CHD的灵敏度、特异度、阳性预测值、曲线下面积(AUC)分别为89.5%、79.5%、87.9%、0.882。结论孕早期UVC血流频谱参数、NT、心轴联合预测胎儿CHD的灵敏度、阳性预测值较高,可作为胎儿CHD早期筛查的客观指标。Objective To investigate the predictive value of the blood flow spectrum parameters of the umbilical venous catheter(UVC),the transparent layer of the neck(NT)and the cardiac axis on the fetal congenital heart malformation(CHD).Methods One hundred and six pregnant women diagnosed with CHD admitted to the hospital from May 2021 to May 2023 and 80 pregnant women with normal fetuses during the same period were compared with the baseline data,UVC flow spectrum parameters[peak ventricular systolic velocity(S),ventricular diastolic peak velocity(D),peak atrial systolic peak velocity(A),A-wave maximum velocity(Tamax),beat index(PI)],NT thickness,and axial angle.Logistic multivariate regression analysis was performed to clearly identify the risk factors affecting fetal CHD,thus establish the prediction model and draw the receiver operatinging characteristic curve(ROC)to evaluate its efficacy.Results There were no significant differences in baseline data of age,gestational age and BMI between the two groups(P>0.05).In the study group,UVC flow spectrum parameters S,D,A,and Tamax were lower than those of the control group,and PI,NT thickness and axis angle were all greater than those of the control group,with significant differences between groups(P<0.05).The results of the logistic multivariate regression analysis showed that:S[P<0.001,OR(95%CI)=1.852(1.584,2.680)],D[P<0.001,OR(95%CI)=1.887(1.644,2.664)],a[P<0.001,OR(95%CI)=1.907(1.609,2.782)],Tamax[P<0.001,OR(95%CI)=2.002(1.827,2.794)],PI[P<0.001,OR(95%CI)=1.992(1.658,2.674)],NT thickness[P<0.001,OR(95%CI)=1.892(1.624,2.691)]and the central axis Angle[P<0.001,OR(95%CI)=1.935(1.650,2.719)]are independent risk factors for fetal CHD.A logistic regression prediction model was constructed based on the parameters affecting the fetal CHD:logistic(P)=-40.125+0.629(S)+0.612(D)+0.644(a)+0.659(Tamax)+0.642(PI)+0.628(NT thickness)+0.650(heart axis angle),predicting sensitivity,specificity,positive predictive value and AUC was 89.5%,79.5%,87.9%and 0.882,respectively.Conclusion The sen

关 键 词：心脏缺损 先天性 脐静脉 导管 血流频谱 孕早期 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.53[医药卫生—诊断学]