胎儿左心房后间隙指数在胎儿肺动脉瓣缺如综合征中的应用价值  

Application value of post-left atrium space index in fetuses with absent pulmonary valve syndrome

作　　者：张盼盼 赵博文[1] 潘美[1] 彭晓慧[1] 陈冉[1] 田园诗[1] 林仙方 惠姗姗[1] 沈婷婷 Panpan Zhang;Bowen Zhao;Mei Pan;Xiaohui Peng;Ran Chen;Yuanshi Tian;Xianfang Lin;Shanshan Hui;Tingting Shen(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 Ultrasound,Taizhou Hospital of Zhejiang Province,Linhai 317000,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]浙江省台州医院超声科,临海317000

出　　处：《中华医学超声杂志（电子版）》2024年第4期391-398,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家重点研发计划项目(2023YFC2705700);浙江大学科学技术研究院一般横向项目(校合-2021-KYY-518053-0055)。

摘　　要：目的定量分析左心房后间隙(PLAS)及左心房后间隙指数(PLASI)在正常胎儿及肺动脉瓣缺如综合征(APVS)胎儿中的变化规律和差异性,探讨PLAS、PLASI在APVS胎儿中的应用价值。方法回顾性分析2011年10月至2023年9月在浙江大学医学院附属邵逸夫医院诊断为APVS的胎儿20例作为APVS组,选取2021年2月至2023年2月连续检查的261例正常胎儿作为对照组。在收缩末期四腔心切面测量PLAS和降主动脉(DA)内径,并计算两者之间的比值,即PLASI。比较对照组与APVS组胎儿的PLAS、DA内径及PLASI,绘制ROC曲线分析PLAS、PLASI诊断APVS的效能。同时,分析对照组及APVS组胎儿的PLAS、DA内径、PLASI与孕龄的关系,以及APVS组胎儿的特征性超声表现及与PLAS、PLASI的相关性。结果APVS组胎儿的PLAS、PLASI明显高于对照组[(4.74±1.38)mm vs(2.70±0.62)mm、1.225±0.210 vs 0.659±0.111,P均<0.0001]。ROC曲线分析显示,PLAS曲线下面积为0.958,当PLAS>3.3 mm时,PLAS鉴别APVS与正常胎儿的敏感度为90%,特异度为85%;PLASI曲线下面积为1.000,当PLASI>0.93时,PLASI鉴别APVS与正常胎儿的敏感度为100%,特异度为99.2%。在对照组中,PLAS与孕龄呈正相关(r=0.5495,P<0.0001),DA内径与孕龄呈正相关(r=0.6327,P<0.0001);在APVS组中,PLAS、DA内径均与孕龄无显著相关性(P均>0.05)。对照组和APVS组的PLASI与孕龄均无显著相关性(P=0.127、0.1008)。PLAS与肺动脉主干内径无明显相关性(P=0.2255),与心轴呈正相关(r=0.5140,P=0.0204)。PLASI与肺动脉主干内径、心轴均无明显相关性(P=0.2180、0.1299)。结论APVS胎儿的PLAS失去正常规律,PLAS与PLASI明显高于正常胎儿。当PLAS>3.3 mm,PLASI介于0.93~1.0之间时,PLAS及PLASI可作为评估APVS的辅助指标。Objective To quantitatively analyze the variations of the post-left atrium space(PLAS)and post-left atrium space index(PLASI)in normal fetuses during the mid-to-late gestational period and fetuses with absent pulmonary valve syndrome(APVS),and to explore the application value of PLAS and PLASI in APVS fetuses.Methods A retrospective analysis was conducted on 20 fetuses diagnosed with APVS at Sir Run Run Shaw Hospital,Zhejiang University College of Medicine from October 2011 to September 2023,as well as 261 normal fetuses consecutively examined between February 2021 and February 2023.Measurements of PLAS and the diameter of the descending aorta(DA)were obtained in the four-chamber view,and PLASI was calculated.PLAS,DA diameter,and PLASI were compared between the control group and the APVS group.Receiver operating characteristic(ROC)curve analysis was performed to assess the diagnostic efficacy of PLAS and PLASI for APVS.Additionally,the relationships between PLAS,DA diameter,PLASI,and gestational age(GA)in both the control and APVS groups were examined.Furthermore,the characteristic ultrasound features of fetuses in the APVS group and their correlations with PLAS and PLASI were analyzed.Results Compared with the control group,the APVS group exhibited significantly higher PLAS and PLASI values[(4.74±1.38)mm vs(2.70±0.62)mm and 1.225±0.210 vs 0.659±0.111,respectively,P<0.0001 for both].ROC curve analysis indicated that the area under the ROC curve of PLAS was 0.958.When PLAS>3.3 mm was used as the cutoff point,the sensitivity and specificity of PLAS in distinguishing APVS from normal fetuses were 90%and 85%,respectively.The area under the ROC curve of PLASI was 1.000,When PLASI>0.93 was used as the cutoff point,the sensitivity and specificity of PLASI in distinguishing APVS from normal fetuses were 100%and 99.2%,respectively.In the control group,PLAS was positively correlated with GA(r=0.5495,P<0.0001),as was the DA diameter(r=0.6327,P<0.0001).In the APVS group,neither PLAS nor DA diameter showed a significant c

关 键 词：左心房后间隙指数 肺动脉瓣缺如综合征 先天性心脏病 胎儿超声心动图 

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]