多普勒超声评估法洛四联症胎儿的肺动脉弹性  

Assessment of pulmonary artery stiffness in fetuses with tetralogy of Fallot

作　　者：刘玉姗 曾施[1] 徐冉[2] 周丹[1] 杨阳[1] 徐赣琼[1] Liu Yushan;Zeng Shi;Xu Ran;Zhou Dan;Yang Yang;Xu Ganqiong(Department of Ultrasound,the Second Xiangya Hospital of Central South University,Changsha 410011,China;Department of Urology,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院超声诊断科,长沙410011 [2]中南大学湘雅二医院泌尿外科,长沙410011

出　　处：《中华超声影像学杂志》2025年第2期149-154,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目(81871372);湖南省自然科学基金项目(2023JJ30743);长沙市自然科学基金项目(kq2208341)。

摘　　要：目的应用多普勒超声心动图评估法洛四联症(TOF)胎儿的肺动脉干(MPA)及左、右分支远段的弹性特征。方法前瞻性收集2022年8月至2023年1月中南大学湘雅二医院的42例TOF胎儿(TOF组)和84例胎龄匹配的正常胎儿(对照组)。将肺动脉瓣环Z-评分按TOF程度分为轻度(Z-评分≥-2)、中度(-4<Z-评分<-2)和重-度(Z-评分≤-4)。在MPA、左肺动脉远段(DLPA)和右肺动脉远段(DRPA)进行脉冲多普勒检查,分别计算以上3个位置的肺动脉硬度(PAS)。比较TOF组与对照组间及TOF亚组间临床资料及超声心动图参数的差异。结果TOF组MPA-PAS大于对照组(P<0.05),DLPA-PAS和DRPA-PAS小于对照组(均P<0.05)。TOF亚组间比较,重度TOF组的MPA-PAS大于轻度、中度TOF组(均P<0.05),三亚组间DLPA-PAS和DRPA-PAS差异无统计学意义(均P>0.05)。结论中晚孕期TOF胎儿的MPA-PAS明显大于正常胎儿。TOF胎儿DLPA-PAS和DRPA-PAS降低。TOF胎儿的肺动脉壁组织学异常在妊娠期间已出现。Objective:To evaluate the elastic characteristics of the pulmonary trunk and its distal branches in fetuses with tetralogy of Fallot(TOF)by Doppler echocardiography.Methods:A total of 42 fetuses with TOF(TOF group)and 84 gestational age-matched normal fetuses(control group)were prospectively collected from the Second Xiangya Hospital of Central South University from August 2022 to January 2023.The severity of TOF was classified into mild TOF(Z-score≥-2),moderate TOF(-4<Z-score<-2)or severe TOF(Z-score≤-4)according to the Z-score value of the pulmonary annulus diameter.The pulmonary artery stiffness(PAS)of the main pulmonary artery(MPA),distal left pulmonary artery(DLPA)and distal right pulmonary artery(DRPA)were measured by pulsed-wave Doppler.The differences of clinical data and echocardiographic parameters between TOF group,control group and among TOF subgroups were compared.Results:Compared with the control group,the control MPA-PAS in fetuses with TOF was significantly higher,and the DLPA-PAS and DRPA-PAS were obviously lower(all P<0.05).The MPA-PAS of fetuses with severe TOF was higher than those with mild and moderate TOF(all P<0.05).However,there were no significant differences in the DLPA-PAS or DRPA-PAS among fetuses with mild TOF,moderate TOF and severe TOF(all P>0.05).Conclusions:Fetuses with TOF present with increased MPA-PAS and decreased stiffness in the distal PA.Histological abnormalities of the pulmonary artery wall in fetuses with TOF have been observed during pregnancy.

关 键 词：超声心动描记术 法洛四联症 胎儿 肺动脉弹性 肺动脉硬度 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]