胎儿心脏超声定量多参数对主动脉缩窄胎儿心脏结构及功能的诊断价值  

Value of multiple fetal echocardiographic quantitative parameters in assessing heart structure and function in fetuses with coarctation of the aorta

作　　者：戴飞 赵博文[1] 潘美[1] 彭晓慧[1] 陈冉[1] 田园诗 狄敏 Dai Fei;Zhao Bowen;Pan Mei;Peng Xiaohui;Chen Ran;Tian Yuanshi;Di Ming(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,Hangzhou No.9 People's Hospital,Hangzhou 311225,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]杭州市第九人民医院超声科,311225

出　　处：《中华医学超声杂志(电子版)》2024年第10期950-958,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家重点研发计划项目(2023YFC2705701);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：目的探讨胎儿心脏定量分析(fetal HQ)技术联合其他胎儿心脏定量多参数在评估主动脉缩窄(CoA)胎儿心脏结构及功能中的应用价值。方法选取2022年1月至2023年1月在浙江大学医学院附属邵逸夫医院超声科行胎儿超声心动图检查疑诊CoA的50例胎儿作为研究对象,将分娩后门诊随访确诊为CoA的胎儿纳入CoA组(18例),将门诊随访明确为CoA假阳性的纳入对照组(32例)。比较2组胎儿的整体心血管参数包括左心室面积变化率(LVFAC)、LVFAC Z-评分、左心室整体纵向应变(LVGLS)、右心室整体纵向应变(RVGLS)、右心室面积/左心室面积(RVA/LVA)、主动脉峡部内径(AI)及其Z评分(AI Z-评分)、主动脉峡部内径/降主动脉内径(AI/DAO)、主肺动脉内径/升主动脉内径(MPA/AAO);比较2组左、右心室24节段的舒张末期横径(ED)、ED Z-评分、短轴缩短率(FS)、FS Z-评分、球形指数(SI)、SI Z-评分。应用多因素Logistic回归分析CoA的独立危险因素;采用ROC曲线分析LVFAC、LVFAC Z-评分、AI及三者联合对胎儿CoA的诊断效能。采用组内相关系数(ICC)判断观察者内及观察者间测量参数的一致性。结果CoA组胎儿的RVA/LVA、MPA/AAO明显高于对照组,LVFAC、LVFAC Z-评分、LVGLS、RVGLS、AI、AI Z-评分、AI/DAO明显低于对照组(P<0.05);CoA组左心室第1节段的ED Z-评分显著低于对照组(P<0.05),左心室第4~8节段的FS、FS Z-评分均显著高于对照组(P<0.05)。LVFAC、LVFAC Z-评分、AI是CoA的独立危险因素(P<0.05);LVFAC、LVFAC Z-评分、AI及三者联合的ROC曲线下面积分别为0.989(0.969~1.000)、0.966(0.922~1.000)、0.785(0.731~0.859)和0.997(0.987~1.000)。观察者内及观察者间测量胎儿各参数的ICC为0.90~0.99。结论fetal HQ联合其他胎儿心脏定量多参数能够有效评估CoA胎儿心脏结构、大小及功能改变,为进一步提高CoA胎儿诊断准确性提供参考信息。Objective To evaluate the value of fetal heart quantitation(fetal HQ)combined with other multiple fetal echocardiographic quantitative parameters in evaluating heart structure and function in fetuses with coarctation of the aorta(CoA).Methods Fifty fetuses suspected of having CoA who underwent fetal echocardiography at the Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University College of Medicine from January 2022 to January 2023 were selected as the study subjects.The fetuses diagnosed with CoA in the outpatient follow-up after delivery were included in a CoA group(18 cases),and those with false-positive results as demonstrated during outpatient follow-up were included in a control group(32 cases).Overall cardiovascular parameters of the two groups of fetuses were compared,including left ventricular fractional area change(LVFAC),LVFAC Z-score,left ventricular global longitudinal strain(LVGLS),right ventricular global longitudinal strain(RVGLS),right ventricular area(RVA)/left ventricular area(LVA)ratio,aortic isthmus inner diameter(AI)and its Z score(AI Z-score),aortic isthmus inner diameter/descending aorta inner diameter ratio(AI/DAO ratio),main pulmonary artery inner diameter/ascending aorta inner diameter ratio(MPA/AAO ratio).The end diastolic transverse diameter(ED),ED Z-score,short axis shortening rate(FS),FS Z-score,sphericity index(SI),and SI Z-score of the 24 segments of the left and right ventricle were also compared between the two groups.Multivariate Logistic regression analysis was performed to identify risk factors for CoA.Receiver operating characteristics(ROC)curve analysis was performed to test the diagnostic efficacy of LVFAC,LVFAC Z-score,AI,and the combination of the three for fetal CoA.Within-group correlation coefficients(ICCs)were used to judge the consistency of measured parameters within and between observers.Results LVFAC,LVFAC Z-score,LVGLS,RVGLS,AI,AI Z-score,and AI/DAO ratio were significantly lower in the CoA group than in the control grou

关 键 词：胎儿 主动脉弓缩窄 胎儿心脏定量分析技术 超声心动图 先天性心脏病 

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]