胎儿超声心动图多参数定量TOF与对合不良型VSD伴PS胎儿心脏形态、大小及功能的对比研究  

Comparative study of cardiac morphology,size and function between fetuses with tetralogy of Fallot and fetuses with malalignment ventricular septal defect and pulmonary stenosis by multi-parameter quantitative echocardiography

作　　者：杨淑丽 赵博文[1] 潘美[1] 彭晓慧[1] 陈冉[1] 田园诗 狄敏 郭河清[3] Yang Shuli;Zhao Bowen;Pan Mei;Peng Xiaohui;Chen Ran;Tian Yuanshi;Di Min;Guo Heqing(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,Shaoring Seventh People's Hospital,Shaoring 312000,China;Department of Ultrasound,Women&Children Hospital of Shaoring,Shaoring 312000,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]绍兴市第七人民医院超声科,绍兴312000 [3]绍兴市妇幼保健院超声科,绍兴312000

出　　处：《中华超声影像学杂志》2025年第2期139-148,共10页Chinese Journal of Ultrasonography

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);浙江省医药卫生项目(2022KY410,2024KY1734)。

摘　　要：目的运用胎儿心脏定量分析(fetal HQ)技术、胎儿超声心动图多参数分析法洛四联症(TOF)与对合不良型室间隔缺损(VSD)伴肺动脉狭窄(PS)即轻型TOF胎儿的心脏大小、形态及功能的差异。方法回顾性选取2021年6月至2023年6月于浙江大学医学院附属邵逸夫医院超声科经胎儿超声心动图诊断TOF胎儿50例(TOF组)及与其孕周相匹配的轻型TOF组34例。利用常规二维超声心动图和M型超声心动图及fetal HQ技术测量两组胎儿心血管基本参数:主动脉内径(AO)及其Z-评分(AO Z-评分)、肺动脉内径(PA)及其Z-评分(PA Z-评分),并计算PA/AO内径比值、主肺动脉内径(MPA)及其Z-评分(MPA Z-评分)、左肺动脉内径(LPA)及其Z-评分(LPA Z-评分)、右肺动脉内径(RPA)及其Z-评分(RPA Z-评分)、McGoon指数(MGI)、三尖瓣环开放最大横径(TV)及Z-评分(TV Z-评分)、二尖瓣环最大开放横径(MV)及其Z-评分(MV Z-评分),并计算MV/TV比值;心室整体形态参数测量:包括心轴,左、右心室横径(LVW、RVW)以及两者比值(LVW/RVW),左、右心室长径(LVL、RVL)以及两者比值(LVL/RVL),左、右心室面积(LVA、RVA)以及两者比值(LVA/RVA),整体球形指数(GSI)及其Z-评分,四腔心舒张末期横径(4CV-Width-ED),四腔心舒张末期纵径(4CV-Length-ED),舒张末期面积(4CV-Area-ED);左、右心室功能参数测量:包括左、右心室面积变化率(LVFAC、RVFAC),左心室射血分数(LVEF),左、右心室纵向应变值(LVGLS、RVGLS)以及左心室和右心室各24节段舒张末期横径(Width-ED),球形指数(SI),短轴缩短率(FS)。比较两组上述参数差异,并分析TOF胎儿左、右心室GLS的绝对值与PA Z-评分、MPA Z-评分、PA/AO的关系。采用二分类Logistic回归模型筛选最佳变量,采用ROC曲线分析超声参数变量对TOF的预测价值。结果TOF组与轻型TOF组的MV、TV、RVW、RVL、LVL、LVA、RVA、4CV-Length-ED、LVGLS、RVGLS、RVFAC,PA/AO、MPA、RPA、LPA、MGI、PA及其Z-评分比较�Objective:To analyze the differences in heart size,shape and function between fetuses with tetralogy of Fallot(TOF)and fetuses with malalignment ventricular septal defect(VSD)and pulmonary stenosis(PS)(named as,mild TOF)by fetal heart quantification(fetal HQ)and multi-parameter fetal echocardiography.Methods:From June 2021 to June 2023,50 fetuses with TOF(TOF group)diagnosed by fetal echocardiography at the Department of Diagnostic Ultrasound&Echocardiography Sir Run Run Shaw Hospital,Zhejiang University College of Medicine and 34 fetuses with VSD and PS matched to gestational age(mild TOF group)were retrospectively selected.Cardiovascular parameters were measured by 2D echocardiography,M-mode echocardiography and fetal HQ,including aortic dimension(AO)and its Z-score(AO Z-score),pulmonary artery diameter(PA)and its Z-score(PA Z-score),PA/AO ratio,main pulmonary artery diameter(MPA)and its Z-score(MPA Z-score),left pulmonary artery diameter(LPA)and its Z-score(LPA Z-score),right pulmonary artery diameter(RPA)and its Z-score(RPA Z-score),McGoon index(MGI),tricuspid annular diameter(TV)and its Z-score(TV Z-score),mitral annular diameter(MV)and its Z-score(MV Z-score),and MV/TV ratio.Measurements of global ventricular morphologic parameters included cardiac axis,left and right ventricular transverse diameters(LVW,RVW)and their ratio(LVW/RVW),left and right ventricular long diameters(LVL,RVL)and LVL/RVL ratio,left and right ventricular areas(LVA,RVA)and LVA/RVA ratio,global spherical index(GSI)and its Z-score,four chamber view transverse diameter(4CV-Width-ED),four chamber view end-diastolic longitudinal diameter(4CV-Length-ED),four chamber view end-diastolic area(4CV-Area-ED).Measurements of left and right global ventricular functional parameters included fractional left ventricular and right ventricular area changes(LVFAC,RVFAC),left ventricular ejection fraction(LVEF),left ventricular and right ventricular global longitudinal strains(LVGLS,RVGLS);end diastolic width diameter(Width-ED),SI and fractional shortening

关 键 词：胎儿心脏定量分析技术 产前诊断 法洛四联症 室间隔缺损伴肺动脉狭窄 

分 类 号：R714.5[医药卫生—妇产科学] R540.45[医药卫生—临床医学]